Individual
MR. JACOB R RICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
500 W GRANT ST, LAKE CITY, MN 55041-1143
(651) 345-3321
Mailing address
500 W GRANT ST, LAKE CITY, MN 55041-1143
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
2066835
MN
367500000X
Certified Registered Nurse Anesthetist
AA093040
ME
367500000X
Certified Registered Nurse Anesthetist
Primary
CRNA 0014
MN
Other
Enumeration date
12/02/2009
Last updated
03/05/2021
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