Provider Demographics
NPI:1801373477
Name:STOCK, RICCA (RN)
Entity Type:Individual
Prefix:
First Name:RICCA
Middle Name:
Last Name:STOCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 W 1650 N
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84404-6100
Mailing Address - Country:US
Mailing Address - Phone:801-603-1785
Mailing Address - Fax:
Practice Address - Street 1:264 W 1650 N
Practice Address - Street 2:
Practice Address - City:HARRISVILLE
Practice Address - State:UT
Practice Address - Zip Code:84404-6100
Practice Address - Country:US
Practice Address - Phone:801-603-1785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5430281-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse