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Individual

AUDRA C RICICA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
5050 N CLINTON ST, FORT WAYNE, IN 46825-5886
(260) 484-8551
(260) 482-5060
Mailing address
5052 N CLINTON ST, FORT WAYNE, IN 46825-5822
(260) 484-8551
(260) 482-5060

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28188589A
IN
367500000X
Certified Registered Nurse Anesthetist
RN-252552
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000208046
ANTHEM
OH
05
200979940
IN
05
2210333
OH
01
430069360
RRMC
OH
Enumeration date
12/01/2005
Last updated
10/30/2018
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