Provider Demographics
NPI:1043552557
Name:RICKS, CAMLOAN AUDUONG (RN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:CAMLOAN
Middle Name:AUDUONG
Last Name:RICKS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14326 SE 87TH PL
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98059-3429
Mailing Address - Country:US
Mailing Address - Phone:425-271-2140
Mailing Address - Fax:
Practice Address - Street 1:14326 SE 87TH PL
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WA
Practice Address - Zip Code:98059-3429
Practice Address - Country:US
Practice Address - Phone:425-271-2140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN 60196669163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant