Individual
MICHELLE RICCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10625 W NORTH AVE STE 102, WAUWATOSA, WI 53226-2315
(414) 877-5350
Mailing address
2454 N 89TH ST, WAUWATOSA, WI 53226-1804
(269) 615-3474
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4141-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1598280695
—
WI
Enumeration date
08/09/2017
Last updated
04/10/2019
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