Individual
MIKA RIDDLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
407 W WALNUT ST, VAN BUREN, IN 46991
(765) 667-4950
Mailing address
407 W WALNUT ST, VAN BUREN, IN 46991-7053
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
32003091A
IN
Other
Enumeration date
03/29/2017
Last updated
03/29/2017
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