Provider Demographics
NPI:1124325196
Name:RICK, NANCY LYNNE (RN, BA)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:LYNNE
Last Name:RICK
Suffix:
Gender:F
Credentials:RN, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 ELDORADO ST NW
Mailing Address - Street 2:APT. 302
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2401
Mailing Address - Country:US
Mailing Address - Phone:612-600-2219
Mailing Address - Fax:
Practice Address - Street 1:11800 ELDORADO ST NW
Practice Address - Street 2:APT. 302
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2401
Practice Address - Country:US
Practice Address - Phone:612-600-2219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-27
Last Update Date:2011-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 99186-3163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse