Individual
MARY G RICKETTS III
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2215 E 52ND ST STE 2, DAVENPORT, IA 52807-2786
(563) 355-7712
(563) 359-1325
Mailing address
2215 E 52ND ST STE 2, DAVENPORT, IA 52807-2786
(563) 355-7712
(563) 359-1325
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
673
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0234526
—
IA
Enumeration date
07/27/2006
Last updated
07/08/2007
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