Provider Demographics
NPI:1184047797
Name:RICE, COLLEEN NICOLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:NICOLE
Last Name:RICE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 WILL PAINTER DR
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5124
Mailing Address - Country:US
Mailing Address - Phone:443-243-3747
Mailing Address - Fax:
Practice Address - Street 1:7505 OSLER DR STE 104
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7737
Practice Address - Country:US
Practice Address - Phone:410-337-8888
Practice Address - Fax:410-823-4833
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005317363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC0005317OtherPA-C LICENSE