| Idris Riddick, LPN | |
|
3872 Wyalusing Ave, Philadelphia, PA 19104-1124 | |
| (610) 679-1723 | |
| Not Available |
| Full Name | Idris Riddick |
|---|---|
| Gender | Male |
| Speciality | Licensed Practical Nurse |
| Location | 3872 Wyalusing Ave, Philadelphia, Pennsylvania |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528543204 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 164W00000X | Licensed Practical Nurse | PN308356 (Pennsylvania) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Idris Riddick, LPN 3872 Wyalusing Ave, Philadelphia, PA 19104-1124 Ph: (610) 679-1723 | Idris Riddick, LPN 3872 Wyalusing Ave, Philadelphia, PA 19104-1124 Ph: (610) 679-1723 |
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