Individual
AUTUMN REBECCA RIDENOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
50 WORKMAN RD, KIMBERLY, WV 25118
(304) 206-1085
Mailing address
PO BOX 231, MOUNT CARBON, WV 25139-0231
(304) 206-1085
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
10/08/2020
Last updated
08/19/2021
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