Provider Demographics
NPI:1447745203
Name:RICE, JACQUELYN MARIE (HIS, LPN)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:MARIE
Last Name:RICE
Suffix:
Gender:F
Credentials:HIS, LPN
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:MARIE
Other - Last Name:EVERETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 ROYS DR STE 1
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-1581
Mailing Address - Country:US
Mailing Address - Phone:574-387-4215
Mailing Address - Fax:
Practice Address - Street 1:130 ROYS DR
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-1581
Practice Address - Country:US
Practice Address - Phone:574-387-4215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27048486A164W00000X
IN17001480A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No164W00000XNursing Service ProvidersLicensed Practical Nurse