Provider Demographics
NPI:1174417281
Name:RIDDERBUSCH, BRIAN FIELDER (RN)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:FIELDER
Last Name:RIDDERBUSCH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11611 NE AINSWORTH CIR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-9017
Mailing Address - Country:US
Mailing Address - Phone:503-255-1841
Mailing Address - Fax:
Practice Address - Street 1:14030 NE SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-3961
Practice Address - Country:US
Practice Address - Phone:503-262-4000
Practice Address - Fax:503-262-4079
Is Sole Proprietor?:No
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202202365RN163W00000X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WS0200XNursing Service ProvidersRegistered NurseSchool