Healthcare Provider Details

I. General information

NPI: 1427325570
Provider Name (Legal Business Name): THERESA ANN RICE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12634 OLIVE BLVD
CREVE COEUR MO
63141-6337
US

IV. Provider business mailing address

9 GREENFIELD DR
SAINT PETERS MO
63376-3013
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-8000
  • Fax:
Mailing address:
  • Phone: 314-494-3424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2011007030
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: