Healthcare Provider Details

I. General information

NPI: 1538980024
Provider Name (Legal Business Name): SALLY RICE CRNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 E LANCASTER AVE STE 210
VILLANOVA PA
19085-1525
US

IV. Provider business mailing address

795 E LANCASTER AVE STE 210
VILLANOVA PA
19085-1525
US

V. Phone/Fax

Practice location:
  • Phone: 215-254-6000
  • Fax:
Mailing address:
  • Phone: 215-254-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP030623
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: