MEDICARE: MS. MARY ANNE RICK PNP FNP-BC

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	363LF0000X	Family Nurse Practitioner	MR202588	MI
2	363LP0200X	Pediatric Nurse Practitioner	MR202588	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0870362	OTHER	MI	BCBSM
2	0C80192	OTHER	MI	BCBSM
3	8320044	OTHER	MI	PHP
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194718478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY ANNE RICK PNP FNP-BC

Provider Business Mailing Address
First Line	:	106 E MAIN ST
Second Line	:	HHWC
City	:	SPRING ARBOR
State	:	MI
Zip	:	49283-9701
Country	:	US
Telephone Number	:	517-750-6352
Fax Number	:	517-750-6625

Provider Business Practice Location Address
First Line	:	106 E MAIN ST
Second Line	:	HHWC
City	:	SPRING ARBOR
State	:	MI
Zip	:	49283-9701
Country	:	US
Telephone Number	:	517-750-6352
Fax Number	:	517-750-6625

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	09/12/2013

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