Provider Demographics
NPI:1891862702
Name:RICE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:RICE MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIABETES CLINICAL NURSE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CNS
Authorized Official - Phone:320-231-8740
Mailing Address - Street 1:301 BECKER AVE SW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-3302
Mailing Address - Country:US
Mailing Address - Phone:320-231-8740
Mailing Address - Fax:320-231-8741
Practice Address - Street 1:301 BECKER AVE SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3302
Practice Address - Country:US
Practice Address - Phone:320-231-8740
Practice Address - Fax:320-231-8741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN128943-5282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural