Provider Demographics
NPI:1700976131
Name:RICE, HEATHER DANETTE (PAC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:DANETTE
Last Name:RICE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:DANETTE
Other - Last Name:PAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:REA CLINIC
Mailing Address - City:CHRASTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822
Mailing Address - Country:US
Mailing Address - Phone:618-724-2401
Mailing Address - Fax:618-724-2571
Practice Address - Street 1:119 GAS PLANT RD
Practice Address - Street 2:REA CLINIC DUQUOIN
Practice Address - City:DUQUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832
Practice Address - Country:US
Practice Address - Phone:618-542-8702
Practice Address - Fax:618-542-8792
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant