Healthcare Provider Details

I. General information

NPI: 1639889801
Provider Name (Legal Business Name): RACHEL ICE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 MARKET AVE S
CANTON OH
44702-2165
US

IV. Provider business mailing address

733 MARKET AVE S
CANTON OH
44702-2165
US

V. Phone/Fax

Practice location:
  • Phone: 330-489-4600
  • Fax:
Mailing address:
  • Phone: 330-489-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN258706
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: