1225022270 NPI number — VICTORIA A RICE ARNP

Table of content: VICTORIA A RICE ARNP (NPI 1225022270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225022270 NPI number — VICTORIA A RICE ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICE
Provider First Name:
VICTORIA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225022270
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 249
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGVIEW
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98632-7154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-414-2048
Provider Business Mailing Address Fax Number:
360-575-6749

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1660 DELAWARE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONGVIEW
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98632-2310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-414-2800
Provider Business Practice Location Address Fax Number:
360-414-2803
Provider Enumeration Date:
09/06/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN00123941 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LX0001X , with the licence number: AP30003981 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 176B00000X , with the licence number: AP30003981 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9618760 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 151802 . This is a "LABOR & IND." identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8930036 . This is a "CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 292431 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500018605 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".