Healthcare Provider Details

I. General information

NPI: 1669848313
Provider Name (Legal Business Name): ERNEST R RICKER CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 N SANDUSKY AVE
UPPER SANDUSKY OH
43351-1031
US

IV. Provider business mailing address

885 N SANDUSKY AVE
UPPER SANDUSKY OH
43351-1031
US

V. Phone/Fax

Practice location:
  • Phone: 419-294-4991
  • Fax: 419-294-2233
Mailing address:
  • Phone: 419-294-4991
  • Fax: 419-294-2233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA-17995-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: