Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | RN237890 | GA |
Y | 363LW0102X | Nurse Practitioner - Women's Health | RN237890 | GA |
NPI | 1063984755 |
---|---|
Provider Name | Aubrey Marie Ricks |
First Address | Brookhaven, GA 30319-3399 |
Second Address | Brookhaven, GA 30319-3399 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2018 |
Last Update Date | 19/12/2018 |