Individual
IDRIS RIDDICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
3872 WYALUSING AVE, PHILADELPHIA, PA 19104-1124
(610) 679-1723
Mailing address
3872 WYALUSING AVE, PHILADELPHIA, PA 19104-1124
(610) 679-1723
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN308356
PA
Other
Enumeration date
09/28/2018
Last updated
09/28/2018
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