Provider Demographics
NPI:1164596854
Name:RICE, IELLAN SCOTT (RN)
Entity Type:Individual
Prefix:MRS
First Name:IELLAN
Middle Name:SCOTT
Last Name:RICE
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 1:116 ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-2417
Mailing Address - Country:US
Mailing Address - Phone:315-446-6039
Mailing Address - Fax:315-446-6039
Practice Address - Street 1:116 ANDREWS RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13214-2417
Practice Address - Country:US
Practice Address - Phone:315-446-6039
Practice Address - Fax:315-446-6039
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01389293163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice