Healthcare Provider Details

I. General information

NPI: 1700976131
Provider Name (Legal Business Name): HEATHER DANETTE RICE PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS HEATHER DANETTE PAGE

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 N VICTOR ST
CHRISTOPHER IL
62822-1529
US

IV. Provider business mailing address

201 BAILEY LN
BENTON IL
62812-1999
US

V. Phone/Fax

Practice location:
  • Phone: 618-435-9699
  • Fax: 618-724-6486
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: