Healthcare Provider Details

I. General information

NPI: 1598383077
Provider Name (Legal Business Name): AUTUMN JOY RICE PNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUTUMN JOY LANTZ

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STANTONSBURG RD
GREENVILLE NC
27834-2818
US

IV. Provider business mailing address

2551 GROVER HARDEE RD
GREENVILLE NC
27858-9154
US

V. Phone/Fax

Practice location:
  • Phone: 252-847-8432
  • Fax:
Mailing address:
  • Phone: 419-799-0382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number5013306
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: