Provider Demographics
NPI:1982001228
Name:RYKAL, DEIDRA MARIE (ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:DEIDRA
Middle Name:MARIE
Last Name:RYKAL
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:MRS
Other - First Name:DEIDRA
Other - Middle Name:MARIE
Other - Last Name:PETERLIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2661 COUNTY HWY I
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729
Mailing Address - Country:US
Mailing Address - Phone:715-726-3485
Mailing Address - Fax:
Practice Address - Street 1:2661 COUNTY HWY I
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729
Practice Address - Country:US
Practice Address - Phone:715-726-3485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5781-33363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health