Provider Demographics
NPI:1427041763
Name:RICE, CYNTHIA MARIE (RNCNP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MARIE
Last Name:RICE
Suffix:
Gender:F
Credentials:RNCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1553 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4135
Mailing Address - Country:US
Mailing Address - Phone:208-233-9355
Mailing Address - Fax:
Practice Address - Street 1:1553 E CENTER ST
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4135
Practice Address - Country:US
Practice Address - Phone:208-233-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN16480363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDBLUE CROSSOtherBLUE CROSS
ID004383300Medicaid
IDR94903Medicare UPIN
ID6100990001Medicare NSC