Provider Demographics
NPI:1033671821
Name:BRICE, RENARDA (RN)
Entity Type:Individual
Prefix:
First Name:RENARDA
Middle Name:
Last Name:BRICE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3319
Mailing Address - Country:US
Mailing Address - Phone:985-732-6615
Mailing Address - Fax:985-732-6621
Practice Address - Street 1:626 CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3319
Practice Address - Country:US
Practice Address - Phone:985-732-6615
Practice Address - Fax:985-732-6621
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA133767163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse