Provider Demographics
NPI:1104483684
Name:RICE, CHRISTIAN (LPN)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:RICE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 BRENTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-3236
Mailing Address - Country:US
Mailing Address - Phone:330-606-3563
Mailing Address - Fax:
Practice Address - Street 1:478 BRENTWOOD AVE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-3236
Practice Address - Country:US
Practice Address - Phone:330-606-3563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH166033164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH166033Medicaid