MEDICARE: SANDRA ADELINA RICKMAN ANP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	303813	NY

General Provider Information

NPI Number	:	1154458230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA ADELINA RICKMAN ANP

Provider Business Mailing Address
First Line	:	5 CEDARWOOD DR
Second Line	:
City	:	FAIRPORT
State	:	NY
Zip	:	14450-9009
Country	:	US
Telephone Number	:	585-223-2131
Fax Number	:

Provider Business Practice Location Address
First Line	:	774 WEST MAIN STREET
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14450-2331
Country	:	US
Telephone Number	:	585-464-8870
Fax Number	:	585-529-5121

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/08/2007

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