Provider Demographics
NPI:1497707202
Name:RICCI, JUDY M (CNP)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:M
Last Name:RICCI
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:M
Other - Last Name:MCEIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:17 EXCHANGE ST W
Mailing Address - Street 2:STE 850
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1045
Mailing Address - Country:US
Mailing Address - Phone:651-232-3900
Mailing Address - Fax:651-232-3956
Practice Address - Street 1:17 EXCHANGE ST W
Practice Address - Street 2:STE 850
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1045
Practice Address - Country:US
Practice Address - Phone:651-232-3900
Practice Address - Fax:651-232-3956
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1296664363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN142252OtherUCARE MN
MN278S2MCOtherBLUE CROSS BLUE SHIELD
MNHP34669OtherHEALTHPARTNERS
MN0108053OtherMEDICA
MN17949676OtherAMERICA'S PPO
WI43957000Medicaid
MN517451100Medicaid
MN500002718Medicare ID - Type Unspecified
MN0108053OtherMEDICA
P50069Medicare UPIN