Provider Demographics
NPI:1124250394
Name:RICCI, ANGELIQUE M (RN)
Entity type:Individual
Prefix:MRS
First Name:ANGELIQUE
Middle Name:M
Last Name:RICCI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:NY
Mailing Address - Zip Code:14522-9430
Mailing Address - Country:US
Mailing Address - Phone:585-770-3911
Mailing Address - Fax:
Practice Address - Street 1:687 SMITH RD
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:NY
Practice Address - Zip Code:14522-9430
Practice Address - Country:US
Practice Address - Phone:585-770-3911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY576374163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse