Provider Demographics
NPI:1154458230
Name:RICKMAN, SANDRA ADELINA (ANP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ADELINA
Last Name:RICKMAN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CEDARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-9009
Mailing Address - Country:US
Mailing Address - Phone:585-223-2131
Mailing Address - Fax:
Practice Address - Street 1:774 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14450-2331
Practice Address - Country:US
Practice Address - Phone:585-464-8870
Practice Address - Fax:585-529-5121
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303813363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health