Healthcare Provider Details

I. General information

NPI: 1558007443
Provider Name (Legal Business Name): TAMIKO RICE MSN, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 12/10/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22777 HARPER AVE
SAINT CLAIR SHORES MI
48080-1868
US

IV. Provider business mailing address

24715 LITTLE MACK AVE STE 200
SAINT CLAIR SHORES MI
48080-3207
US

V. Phone/Fax

Practice location:
  • Phone: 586-588-9441
  • Fax:
Mailing address:
  • Phone: 517-882-3732
  • Fax: 517-882-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704366856
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704366856
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: