Provider Demographics
NPI:1497719090
Name:RALICKI, ROBIN A (NP)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:A
Last Name:RALICKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8019
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01102-8000
Mailing Address - Country:US
Mailing Address - Phone:866-431-4077
Mailing Address - Fax:413-774-7448
Practice Address - Street 1:329 CONWAY ST
Practice Address - Street 2:GREENFIELD HEALTH CENTER
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1526
Practice Address - Country:US
Practice Address - Phone:413-774-6301
Practice Address - Fax:413-774-6528
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA100668363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA100668OtherCONNECTICARE
MANP1663OtherBLUE CROSS BLUE SHIELD
MA500016130OtherRAILROAD MEDICARE
MA1295087OtherFALLON COMMUNITY HEALTH PLAN
MA0351041Medicaid
MAS75174Medicare UPIN
MA0351041Medicaid