Provider Demographics
NPI:1306097753
Name:RICKER, JENNIFER MCLURE (RN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MCLURE
Last Name:RICKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:JOY
Other - Last Name:RICKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1110 PARKER RD
Mailing Address - Street 2:
Mailing Address - City:VERSHIRE
Mailing Address - State:VT
Mailing Address - Zip Code:05079-9505
Mailing Address - Country:US
Mailing Address - Phone:802-685-3252
Mailing Address - Fax:
Practice Address - Street 1:1110 PARKER RD
Practice Address - Street 2:
Practice Address - City:VERSHIRE
Practice Address - State:VT
Practice Address - Zip Code:05079-9505
Practice Address - Country:US
Practice Address - Phone:802-685-3252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0260012973163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse