Provider Demographics
NPI:1689336083
Name:BRICE, NASTASSHA (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:NASTASSHA
Middle Name:
Last Name:BRICE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1961 SERENA AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-2845
Mailing Address - Country:US
Mailing Address - Phone:559-970-5619
Mailing Address - Fax:
Practice Address - Street 1:149 OAK AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-7228
Practice Address - Country:US
Practice Address - Phone:559-970-5619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility