Provider Demographics
NPI:1497044051
Name:RICE, PETRIE ODETTA
Entity Type:Individual
Prefix:MRS
First Name:PETRIE
Middle Name:ODETTA
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 1:14152 FOOTHILL BLVD
Mailing Address - Street 2:#3
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-8000
Mailing Address - Country:US
Mailing Address - Phone:818-367-9235
Mailing Address - Fax:
Practice Address - Street 1:14152 FOOTHILL BLVD.
Practice Address - Street 2:#3
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342
Practice Address - Country:US
Practice Address - Phone:818-367-9235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN167990164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse