Individual
MRS. KAREN L RIDENOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
F.N.P., BC
Contact information
Practice address
701 N FIRST ST MEMORIAL HEALTH SYSTEM, MIDWEST EMERGENCY DEPT SPECIALISTS, SPRINGFIELD, IL 62781-0001
(618) 498-7108
(618) 498-7919
Mailing address
6810 STATE ROUTE 162 STE 215, MARYVILLE, IL 62062-8566
(618) 391-6410
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
209009534
IL
363LF0000X
Family Nurse Practitioner
Primary
209009534
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209009534
—
IL
Enumeration date
05/08/2012
Last updated
01/05/2022
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