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NPI Code Detail

MEDICARE: MISS JANE A. RICKMAN CRNA

MEDICARE: MISS JANE A. RICKMAN CRNA
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
1163W00000XRegistered Nurse041-152963IL
2367500000XCertified Registered Nurse Anesthetist209-001566IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00944335OTHERILRR MEDICARE

General Provider Information

NPI Number : 1982609343
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS JANE A. RICKMAN CRNA
Provider Business Mailing Address
First Line : 2202 HARLEM ROAD
Second Line : SUITE 200
City : LOVES PARK
State : IL
Zip : 61111-2754
Country : US
Telephone Number : 815-877-4848
Fax Number : 815-654-5342
Provider Business Practice Location Address
First Line : 2202 HARLEM ROAD
Second Line : SUITE 200
City : LOVES PARK
State : IL
Zip : 61111-2754
Country : US
Telephone Number : 815-877-4848
Fax Number : 815-654-5342
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2005
Last Update Date : 04/26/2017

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Directions to “ MISS JANE A. RICKMAN CRNA” Practice Location

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