Individual
DEIDRA L RICKMAN-JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4701 MACCORKLE AVE, THE DAY SURGERY CENTER, CHARLESTON, WV 25304
(304) 925-9300
(304) 925-9287
Mailing address
PO BOX 11686, NAPS INC, CHARLESTON, WV 25339
(304) 346-7313
(304) 744-9802
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
29857
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0065221000
—
WV
01
—
27005299700
BRICKSTREET
WV
Enumeration date
07/11/2006
Last updated
07/08/2007
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