Healthcare Provider Details

I. General information

NPI: 1740557677
Provider Name (Legal Business Name): AMY RICKER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 DEFENSE HWY SUITE 400
ANNAPOLIS MD
21401-7027
US

IV. Provider business mailing address

116 DEFENSE HWY SUITE 400
ANNAPOLIS MD
21401-7027
US

V. Phone/Fax

Practice location:
  • Phone: 410-897-9841
  • Fax: 410-897-9852
Mailing address:
  • Phone: 410-897-9841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR173595
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: