Provider Demographics
NPI:1093032971
Name:RICKNER, SHARON D (LPN)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:D
Last Name:RICKNER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7715 W PORT BAY RD
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:NY
Mailing Address - Zip Code:14590-9593
Mailing Address - Country:US
Mailing Address - Phone:315-594-2865
Mailing Address - Fax:
Practice Address - Street 1:7715 W PORT BAY RD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:NY
Practice Address - Zip Code:14590-9593
Practice Address - Country:US
Practice Address - Phone:315-594-2865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287947-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse