Provider Demographics
NPI:1881061869
Name:RICKS-ROSS, MAGGIE SELINA (RN)
Entity type:Individual
Prefix:
First Name:MAGGIE
Middle Name:SELINA
Last Name:RICKS-ROSS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:SELINA
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:5151 W SILVER SPRING DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-3300
Mailing Address - Country:US
Mailing Address - Phone:414-527-6940
Mailing Address - Fax:414-527-6941
Practice Address - Street 1:5151 W SILVER SPRING DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-3300
Practice Address - Country:US
Practice Address - Phone:414-527-6940
Practice Address - Fax:414-527-6941
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2888531164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse