Provider Demographics
NPI:1720683402
Name:GIUDICELLI, RINA WILKES
Entity Type:Individual
Prefix:
First Name:RINA
Middle Name:WILKES
Last Name:GIUDICELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 E RAGUSA LN
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9040
Mailing Address - Country:US
Mailing Address - Phone:208-766-3391
Mailing Address - Fax:
Practice Address - Street 1:7 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2742
Practice Address - Country:US
Practice Address - Phone:541-889-6119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202010275NP-PP363LF0000X
ID66271363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily