1073007282 NPI number — MRS. MONTHIA ALLISON RICKETTS RN, BSN

Table of content: MRS. MONTHIA ALLISON RICKETTS RN, BSN (NPI 1073007282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073007282 NPI number — MRS. MONTHIA ALLISON RICKETTS RN, BSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICKETTS
Provider First Name:
MONTHIA
Provider Middle Name:
ALLISON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, BSN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAKER
Provider Other First Name:
VERONICA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1073007282
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5841 NW 56TH PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMARAC
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-460-9295
Provider Business Mailing Address Fax Number:
954-720-4563

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5841 NW 56TH PLACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMARAC
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-640-9295
Provider Business Practice Location Address Fax Number:
954-720-4563
Provider Enumeration Date:
06/20/2018

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: 163W00000X , with the licence number:  9200440 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com