Individual
JACQUELYN MARIE RICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
HIS, LPN
Contact information
Practice address
130 ROYS DR, MISHAWAKA, IN 46544-1581
(574) 387-4215
Mailing address
130 ROYS DR STE 1, MISHAWAKA, IN 46544-1581
(574) 387-4215
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
27048486A
IN
237700000X
Hearing Instrument Specialist
Primary
17001480A
IN
Other
Enumeration date
06/25/2018
Last updated
06/25/2018
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