Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | 107.0051633 | VT |
Y | 176B00000X | Midwife | P78239 | NY |
NPI | 1164724316 |
---|---|
Provider Name | Heidi Ricks I |
First Address | Ballston Lake, NY 12019-1929 |
Second Address | Troy, NY 12180-3359 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2010 |
Last Update Date | 21/11/2010 |