Provider Demographics
NPI:1760255541
Name:RICCI, JADE LILY
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:LILY
Last Name:RICCI
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 1:4343 LACLEDE AVE APT G
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2253
Mailing Address - Country:US
Mailing Address - Phone:408-455-8909
Mailing Address - Fax:
Practice Address - Street 1:1027 BELLEVUE AVE FL 3
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1996
Practice Address - Country:US
Practice Address - Phone:314-768-5202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician