| Doctor Name: | CHRISTINA FULTZ RICKENBACK |
| NPI Number: | 1104831460 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | 000028 |
| Business Practice Address: | One Wildwood Medical Center Essex, CT - 06426 |
| Business Phone Number: | 8607670168 |
| Business Fax Number: | 8607671803 |
| Mailing Address: | One Wildwood Medical Center, ESSEX |
| State: | CT |
| Postal Code: | 06426 |
| Phone Number: | 8607670168 |
| Fax Number: | 8607671803 |
| NPI Enumeration Date: | 07/29/2006 |
| NPI Last Update Date: | 08/10/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 000028 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |