Healthcare Provider Details

I. General information

NPI: 1659746550
Provider Name (Legal Business Name): WENDY J RICKERD FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2015
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 MASSILLON RD STE 102
AKRON OH
44312-5982
US

IV. Provider business mailing address

3333 MASSILLON RD STE 102
AKRON OH
44312-5982
US

V. Phone/Fax

Practice location:
  • Phone: 330-926-3235
  • Fax: 330-255-5084
Mailing address:
  • Phone: 855-925-4733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN.252149-1
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.17435
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: