Healthcare Provider Details

I. General information

NPI: 1851033716
Provider Name (Legal Business Name): GERALDINE LYNN RICE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4326 W MONTROSE AVE
CHICAGO IL
60641-2016
US

IV. Provider business mailing address

4326 W MONTROSE AVE
CHICAGO IL
60641-2016
US

V. Phone/Fax

Practice location:
  • Phone: 773-883-9100
  • Fax: 773-883-0005
Mailing address:
  • Phone: 773-883-9100
  • Fax: 773-883-0005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number041522806
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: