Provider Demographics
NPI:1407198476
Name:VALLEE, TASHA RICKERMANN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:RICKERMANN
Last Name:VALLEE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:D
Other - Last Name:RICKERMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:1905 JEFFERSON ST STE B
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-5652
Mailing Address - Country:US
Mailing Address - Phone:217-577-2992
Mailing Address - Fax:217-214-6785
Practice Address - Street 1:1905 JEFFERSON ST STE B
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-5652
Practice Address - Country:US
Practice Address - Phone:217-577-2992
Practice Address - Fax:217-214-6785
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006019144163W00000X
MO2013006672363LF0000X
IL209010408363LF0000X
IL277001714363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse