Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 209013054 | IL |
NPI | 1003285032 |
---|---|
Provider Name | Mrs. Patricia Ann Rice |
First Address | Peoria, IL 61602-1571 |
Second Address | Galesburg, IL 61401-2807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2015 |
Last Update Date | 22/09/2015 |