Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | NP5787 | CA |
NPI | 1003903469 |
---|---|
Provider Name | Ms. Sandra Jo Rice |
First Address | Chico, CA 95928-9159 |
Second Address | Chico, CA 95929-0777 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 16/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NP5787 | LICENSE (01) | CA |