Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 01050968 | IN |
N | 208000000X | Pediatrician | 01050968A | IN |
NPI | 1114240678 |
---|---|
Provider Name | Christina Margaret Ricks |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-5128 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2010 |
Last Update Date | 23/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200345680 | (05) | IN |