Provider Demographics
NPI:1104205236
Name:RICE, DENISE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:RICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 MOONLIGHT RD
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:SC
Mailing Address - Zip Code:29853-3713
Mailing Address - Country:US
Mailing Address - Phone:803-259-8870
Mailing Address - Fax:803-541-1193
Practice Address - Street 1:835 MOONLIGHT RD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:SC
Practice Address - Zip Code:29853-3713
Practice Address - Country:US
Practice Address - Phone:803-259-8870
Practice Address - Fax:803-541-1193
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC90916163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse