Healthcare Provider Details

I. General information

NPI: 1508634825
Provider Name (Legal Business Name): KEVIN RICE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2023
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 18TH AVE S
SEATTLE WA
98144-4317
US

IV. Provider business mailing address

10526 SW BURTON DR
VASHON WA
98070-7086
US

V. Phone/Fax

Practice location:
  • Phone: 206-731-7210
  • Fax:
Mailing address:
  • Phone: 206-551-9991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN60454987
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: