Provider Demographics
NPI:1194718478
Name:RICK, MARY ANNE (PNP FNP-BC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANNE
Last Name:RICK
Suffix:
Gender:F
Credentials:PNP FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 E MAIN ST
Mailing Address - Street 2:HHWC
Mailing Address - City:SPRING ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49283-9701
Mailing Address - Country:US
Mailing Address - Phone:517-750-6352
Mailing Address - Fax:517-750-6625
Practice Address - Street 1:106 E MAIN ST
Practice Address - Street 2:HHWC
Practice Address - City:SPRING ARBOR
Practice Address - State:MI
Practice Address - Zip Code:49283-9701
Practice Address - Country:US
Practice Address - Phone:517-750-6352
Practice Address - Fax:517-750-6625
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMR202588363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0870362OtherBCBSM
MI0C80192OtherBCBSM
MI8320044OtherPHP
MI4634780Medicaid
MI4634780Medicaid
MIOP13090Medicare PIN