Provider Demographics
NPI:1992252605
Name:RICKS, SONIA R (LPN)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:R
Last Name:RICKS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SONIA
Other - Middle Name:R
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:203 GENUNG ST
Mailing Address - Street 2:APT 609
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2557
Mailing Address - Country:US
Mailing Address - Phone:315-955-4739
Mailing Address - Fax:
Practice Address - Street 1:203 GENUNG ST
Practice Address - Street 2:APT 609
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2557
Practice Address - Country:US
Practice Address - Phone:315-955-4739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-10
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253948-1164W00000X
OH159425164W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No164W00000XNursing Service ProvidersLicensed Practical Nurse