Provider Demographics
NPI:1922265719
Name:RICE, STACY ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:ANN
Last Name:RICE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:STACY
Other - Middle Name:ANN
Other - Last Name:DEKING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:305 MACKAY AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-1011
Mailing Address - Country:US
Mailing Address - Phone:315-488-7466
Mailing Address - Fax:
Practice Address - Street 1:305 MACKAY AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-1011
Practice Address - Country:US
Practice Address - Phone:315-488-7466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261890-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse