Individual
MRS. REBECCA LAUREN RIDENOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
720 ESKENAZI AVE, INDIANAPOLIS, IN 46202-5187
(317) 880-7666
(317) 880-0448
Mailing address
PO BOX 637764, CINCINNATI, OH 45263-7764
(317) 880-3939
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71008204A
IN
363LA2100X
Acute Care Nurse Practitioner
71008204A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28216997A
INDIANA PROFESSIONAL LICENSING AGENCY
IN
Enumeration date
05/21/2018
Last updated
09/29/2025
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