Provider Demographics
NPI:1831913789
Name:TRICE, TIESHA M
Entity type:Individual
Prefix:
First Name:TIESHA
Middle Name:M
Last Name:TRICE
Suffix:
Gender:F
Credentials:
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:19710 GOVERNORS HWY STE 5
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-2081
Mailing Address - Country:US
Mailing Address - Phone:815-531-7208
Mailing Address - Fax:708-794-3666
Practice Address - Street 1:19710 GOVERNORS HWY STE 5
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2081
Practice Address - Country:US
Practice Address - Phone:815-531-7208
Practice Address - Fax:708-794-3666
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy