1730468083 NPI number — WYNNE DEE RINICKER APRN/MASTER FNP

Table of content: WYNNE DEE RINICKER APRN/MASTER FNP (NPI 1730468083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730468083 NPI number — WYNNE DEE RINICKER APRN/MASTER FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RINICKER
Provider First Name:
WYNNE
Provider Middle Name:
DEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN/MASTER FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730468083
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1288
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINNFIELD
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71483-1288
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-209-4510
Provider Business Mailing Address Fax Number:
318-209-4519

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1140 S VIENNA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUSTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71270-5834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-224-7190
Provider Business Practice Location Address Fax Number:
318-224-7194
Provider Enumeration Date:
08/04/2011

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: 363L00000X , with the licence number:  AP06607 , registered in the state of LA ; 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