MEDICARE: CYNTHIA ANNE RICKSON RN

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	163W00000X	Registered Nurse	026-0015479	VT

General Provider Information

NPI Number	:	1215634282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA ANNE RICKSON RN

Provider Business Mailing Address
First Line	:	2 VILLAGE CT
Second Line	:
City	:	GRAND ISLE
State	:	VT
Zip	:	05458-2031
Country	:	US
Telephone Number	:	802-497-4247
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 CHEROKEE AVE
Second Line	:
City	:	ESSEX JUNCTION
State	:	VT
Zip	:	05452-3593
Country	:	US
Telephone Number	:	802-318-3801
Fax Number	:

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

Provider Enumeration Date	:	02/10/2023
Last Update Date	:	02/10/2023

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