Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 4704163245 | MI |
NPI | 1235332677 |
---|---|
Provider Name | Mrs. Collette Renee Rice |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Big Rapids, MI 49307-2048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 22/02/2021 |