Healthcare Provider Details

I. General information

NPI: 1851094007
Provider Name (Legal Business Name): EMMA RAE RICE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5103 MAPLE LN
CROSS LANES WV
25313-2133
US

IV. Provider business mailing address

5103 MAPLE LN
CROSS LANES WV
25313-2133
US

V. Phone/Fax

Practice location:
  • Phone: 304-674-5114
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: