Healthcare Provider Details

I. General information

NPI: 1275581159
Provider Name (Legal Business Name): ASHONDA T-KAY TRICE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WEED ARMY COMMUNITY HOSPITAL
FORT IRWIN CA
92310
US

IV. Provider business mailing address

8407 B. REMAGEN DR.
FORT IRWIN CA
92310
US

V. Phone/Fax

Practice location:
  • Phone: 760-380-3185
  • Fax:
Mailing address:
  • Phone: 760-386-0408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001180118
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: