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General NPI Number Information
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NPI Number | 1972030922
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Entity Type | Individual
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Provider Name | LOIC RICKEL ASSOBMO CNP
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Gender | Male
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Dates
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Enumeration Date | 05/20/2017
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 21 DWIGHT RD
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City | LONGMEADOW
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State | MA
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Zip | 01106-1765
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Country | US
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Telephone | 413-795-4555
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Fax | 413-794-9448
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Provider Business Mailing Address
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Address Line | 235 CHESTNUT ST # 12
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City | SPRINGFIELD
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State | MA
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Zip | 01103-1100
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Country | US
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Telephone | 413-438-5737
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Fax | 413-451-1211
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2310024
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License Number State | MA
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