Healthcare Provider Details

I. General information

NPI: 1437601705
Provider Name (Legal Business Name): CHRISTA M RICK CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 WASHINGTON ST
WATERTOWN NY
13601-4036
US

IV. Provider business mailing address

PO BOX 91
WATERTOWN NY
13601-0091
US

V. Phone/Fax

Practice location:
  • Phone: 315-788-2003
  • Fax: 315-788-7087
Mailing address:
  • Phone: 315-782-4207
  • Fax: 315-782-8699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberF001766
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number001766
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: