1770685711 NPI number — MS. NICOLE KNOX RICCIONI RN, CPNP

Table of content: MS. NICOLE KNOX RICCIONI RN, CPNP (NPI 1770685711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770685711 NPI number — MS. NICOLE KNOX RICCIONI RN, CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICCIONI
Provider First Name:
NICOLE
Provider Middle Name:
KNOX
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN, CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KNOX-BIMLER
Provider Other First Name:
NICOLE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, CPNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770685711
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6621 FANNIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77030-2358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-826-5334
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6621 FANNIN ST
Provider Second Line Business Practice Location Address:
WT6-006
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-2303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-826-5334
Provider Business Practice Location Address Fax Number:
832-825-5241
Provider Enumeration Date:
09/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  663122 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)