Healthcare Provider Details

I. General information

NPI: 1255841250
Provider Name (Legal Business Name): JOANNA M RICE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANN HATTON RN

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date: 08/09/2021
Reactivation Date: 11/10/2022

III. Provider practice location address

VISN 20 CLINICAL RESOURCE HUB, BOISE VA MEDICAL CENTER 500 W FORT ST
BOISE ID
83702
US

IV. Provider business mailing address

VISN 20 CLINICAL RESOURCE HUB, BOISE VA MEDICAL CENTER 500 W FORT ST
BOISE ID
83702
US

V. Phone/Fax

Practice location:
  • Phone: 208-422-1000
  • Fax: 208-422-1038
Mailing address:
  • Phone: 208-422-1000
  • Fax: 208-422-1038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number200440946RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: