Healthcare Provider Details

I. General information

NPI: 1639305352
Provider Name (Legal Business Name): EVELYN L RIKE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 06/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4929 W. FOND DU LAC BELL THERAPY CSP-NORTH/FAMILY CARE
MILWAUKEE WI
53216-2324
US

IV. Provider business mailing address

4929 W. FOND DU LAC AVE. BELL THERAPY CSP-NORTH/FAMILY CARE
MILWAUKEE WI
53216-2324
US

V. Phone/Fax

Practice location:
  • Phone: 414-871-6122
  • Fax: 414-871-0221
Mailing address:
  • Phone: 414-871-6122
  • Fax: 414-871-0221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number165412-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: