MEDICARE: NICKI ANN RIECKHOFF RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	49921-030	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1633WHO200X	OTHER	WI	INDEPENDENT NURSE
2	163WH0200X	OTHER	WI	RN HOME HEALTH

General Provider Information

NPI Number	:	1952375602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICKI ANN RIECKHOFF RN

Provider Business Mailing Address
First Line	:	2045 S 73RD ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53219-1213
Country	:	US
Telephone Number	:	414-329-1054
Fax Number	:	414-329-1053

Provider Business Practice Location Address
First Line	:	2045 S 73RD ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53219-1213
Country	:	US
Telephone Number	:	414-329-1054
Fax Number	:	414-329-1053

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	07/08/2007

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