Healthcare Provider Details

I. General information

NPI: 1962728089
Provider Name (Legal Business Name): RIKKI ROSE SCHUSTER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 EAGLE DR
KILL DEVIL HILLS NC
27948-8605
US

IV. Provider business mailing address

306 EAGLE DR
KILL DEVIL HILLS NC
27948-8605
US

V. Phone/Fax

Practice location:
  • Phone: 252-202-2007
  • Fax: 252-480-4608
Mailing address:
  • Phone: 252-202-2007
  • Fax: 252-480-4608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number103018
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: