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General NPI Number Information
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NPI Number | 1356672349
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Entity Type | Organization
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Legal Business Name | REBECCA NICE DO LLC
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Dates
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Enumeration Date | 01/15/2010
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Last Update Date | 02/25/2013
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Provider Practice Location Address
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Address Line | 6 CAROUSEL DR
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City | TELFORD
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State | PA
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Zip | 18969-2009
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Country | US
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Telephone | 215-837-0166
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Fax |
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Provider Business Mailing Address
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Address Line | 6 CAROUSEL DR
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City | TELFORD
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State | PA
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Zip | 18969-2009
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Country | US
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Telephone | 215-837-0166
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | REBECCA NICE
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Credential | DO
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Telephone | 215-837-0166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS013478
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License Number State | PA
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