Provider Demographics
NPI:1699240721
Name:RICKMAN, SANDRA ARLINE (FNP-C)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ARLINE
Last Name:RICKMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 STONECLIFF
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-3917
Mailing Address - Country:US
Mailing Address - Phone:575-491-9636
Mailing Address - Fax:
Practice Address - Street 1:BASTOGNE EXTENSION
Practice Address - Street 2:
Practice Address - City:FORT LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:28310-5044
Practice Address - Country:US
Practice Address - Phone:910-907-2575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM54012363LF0000X, 171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMCNP-54012OtherCNP