Provider Demographics
NPI:1922648773
Name:RICE, AUDRIANNA CRYSTAL
Entity Type:Individual
Prefix:
First Name:AUDRIANNA
Middle Name:CRYSTAL
Last Name:RICE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:AUDRIANNA
Other - Middle Name:CRYSTAL
Other - Last Name:ALVARADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1586 MADONNA RD APT 104
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-8720
Mailing Address - Country:US
Mailing Address - Phone:805-904-4770
Mailing Address - Fax:
Practice Address - Street 1:1586 MADONNA RD APT 104
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-8720
Practice Address - Country:US
Practice Address - Phone:805-904-4770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA708765164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse