Healthcare Provider Details

I. General information

NPI: 1215990890
Provider Name (Legal Business Name): KAREN FRANCES RICCI CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 BOATNER RD SUITE 114
EGLIN AFB FL
32542-1391
US

IV. Provider business mailing address

7601 CERVANTES CT
SPRINGFIELD VA
22153-1607
US

V. Phone/Fax

Practice location:
  • Phone: 850-883-8891
  • Fax:
Mailing address:
  • Phone: 703-455-9016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0024166812
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: