MEDICARE: MARIJA S RICE CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN634681	PA
2	207Q00000X	Family Medicine Physician	SP019633	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710462486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIJA S RICE CRNP

Provider Business Mailing Address
First Line	:	4400 PENN AVE
Second Line	:
City	:	SINKING SPRING
State	:	PA
Zip	:	19608-8621
Country	:	US
Telephone Number	:	610-670-2522
Fax Number	:	610-670-7736

Provider Business Practice Location Address
First Line	:	4400 PENN AVE
Second Line	:
City	:	SINKING SPRING
State	:	PA
Zip	:	19608-8621
Country	:	US
Telephone Number	:	610-670-2522
Fax Number	:	610-670-7736

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2018
Last Update Date	:	09/27/2023

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