Provider Demographics
NPI:1568278653
Name:RICKS, SHIRLEY GAIL
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:GAIL
Last Name:RICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 LEES MILL DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-5029
Mailing Address - Country:US
Mailing Address - Phone:757-817-6979
Mailing Address - Fax:
Practice Address - Street 1:11817 CANON BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2569
Practice Address - Country:US
Practice Address - Phone:757-817-6979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle