Individual
ELGERENE MONIQUE RIDDERHEIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6279 E STATE BLVD, FORT WAYNE, IN 46815-7641
(260) 492-0951
Mailing address
6729 EAST STATE BLVD, FORT WAYNE, IN 46815
(260) 492-0951
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71008116A
IN
363LF0000X
Family Nurse Practitioner
Primary
71008116A
IN
Other
Enumeration date
05/16/2018
Last updated
11/06/2024
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