Provider Demographics
NPI:1154494391
Name:RICKE, CHARLOTTE ANNE (RT (ARRT))
Entity type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:ANNE
Last Name:RICKE
Suffix:
Gender:F
Credentials:RT (ARRT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9811 P CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-2132
Mailing Address - Country:US
Mailing Address - Phone:402-334-0613
Mailing Address - Fax:401-501-0475
Practice Address - Street 1:1400 DOUGLAS ST STOP 0030
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68179-0030
Practice Address - Country:US
Practice Address - Phone:402-544-3847
Practice Address - Fax:402-501-0475
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5472471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE547OtherMEDICAL RADIOLOGRAPHER LI