Individual
CHRISTOPHER V RICKETTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
415 6TH ST, LEWISTON, ID 83501-2431
(208) 799-5280
Mailing address
415 6TH ST, LEWISTON, ID 83501-2431
(208) 799-5280
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PAG-021
ID
Other
Enumeration date
11/19/2010
Last updated
11/19/2010
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