Individual
TERRY TICEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1700 IOWA AVE, SUITE 230, RIVERSIDE, CA 92507-2420
(951) 369-8604
(951) 715-4594
Mailing address
14227 REMINGTON CT, FONTANA, CA 92336-3527
(909) 429-0234
Taxonomy
Speciality
Code
Description
License number
State
163WH1000X
Hospice Registered Nurse
Primary
513954
CA
Other
Enumeration date
02/06/2007
Last updated
07/08/2007
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