Individual
GREGORY RIDENOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7950 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 435-7001
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 479-3516
(260) 479-3520
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
APRN.CNP.019874
OH
363LN0005X
Critical Care Neonatal Nurse Practitioner
APRN.CNP.019874
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0265386
—
OH
Enumeration date
09/13/2016
Last updated
04/25/2025
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