Healthcare Provider Details

I. General information

NPI: 1730468083
Provider Name (Legal Business Name): WYNNE DEE RINICKER APRN/MASTER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 S VIENNA ST
RUSTON LA
71270-5834
US

IV. Provider business mailing address

PO BOX 1288
WINNFIELD LA
71483-1288
US

V. Phone/Fax

Practice location:
  • Phone: 318-224-7190
  • Fax: 318-224-7194
Mailing address:
  • Phone: 318-209-4510
  • Fax: 318-209-4519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP06607
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: