Healthcare Provider Details

I. General information

NPI: 1699742866
Provider Name (Legal Business Name): MARY RICKMAN ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 E BELL RD SUITE 3100
PHOENIX AZ
85032-2136
US

IV. Provider business mailing address

PO BOX 98819
LAS VEGAS NV
89193
US

V. Phone/Fax

Practice location:
  • Phone: 602-867-8644
  • Fax: 602-795-5698
Mailing address:
  • Phone: 602-494-3659
  • Fax: 602-494-3682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN053459
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: