Healthcare Provider Details

I. General information

NPI: 1740498914
Provider Name (Legal Business Name): JOANNE RICCA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 WALDO AVE BELFAST FAMILY PLANNING
BELFAST ME
04915-6922
US

IV. Provider business mailing address

20 PINES RD
SEARSMONT ME
04973-3818
US

V. Phone/Fax

Practice location:
  • Phone: 207-338-3736
  • Fax:
Mailing address:
  • Phone: 207-342-3688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR020016
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: