Provider Demographics
NPI:1710749866
Name:RIFE, THERESA ANN
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:RIFE
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 1:1017 S MAIN ST APT 41
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-4727
Mailing Address - Country:US
Mailing Address - Phone:812-703-3503
Mailing Address - Fax:
Practice Address - Street 1:1017 S MAIN ST APT 41
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-4727
Practice Address - Country:US
Practice Address - Phone:812-703-3503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant