Provider Demographics
NPI:1205922804
Name:RICE, MARCELLA M (ANP-C)
Entity type:Individual
Prefix:MS
First Name:MARCELLA
Middle Name:M
Last Name:RICE
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:JENILA
Other - Middle Name:
Other - Last Name:RICE-MANDERVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 PATROON CREEK BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-5014
Mailing Address - Country:US
Mailing Address - Phone:518-445-4340
Mailing Address - Fax:518-445-4360
Practice Address - Street 1:400 PATROON CREEK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-5014
Practice Address - Country:US
Practice Address - Phone:518-445-4340
Practice Address - Fax:518-445-4360
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300604363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02251861Medicaid
NYRB8481Medicare PIN
NY02251861Medicaid