Healthcare Provider Details

I. General information

NPI: 1982125464
Provider Name (Legal Business Name): JEANMARIE RICKS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12010 S WARNER ELLIOT LOOP STE 1
PHOENIX AZ
85044-2731
US

IV. Provider business mailing address

2010 S DOBSON RD
CHANDLER AZ
85286-7374
US

V. Phone/Fax

Practice location:
  • Phone: 480-961-2366
  • Fax:
Mailing address:
  • Phone: 443-803-8361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10127
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR138811
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: