Provider Demographics
NPI:1184371437
Name:RICKE, TAYLOR LYNNE (NP)
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:LYNNE
Last Name:RICKE
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 1:1205 3RD ST SW
Mailing Address - Street 2:
Mailing Address - City:RICE
Mailing Address - State:MN
Mailing Address - Zip Code:56367-8846
Mailing Address - Country:US
Mailing Address - Phone:612-600-2298
Mailing Address - Fax:
Practice Address - Street 1:1360 ELM ST E
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MN
Practice Address - Zip Code:56374-4694
Practice Address - Country:US
Practice Address - Phone:320-363-7765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8433363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily