=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710462486
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIJA S RICE CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2018
-----------------------------------------------------
Last Update Date | 06/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4400 PENN AVE
-----------------------------------------------------
City | SINKING SPRING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19608-8621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-670-2522
-----------------------------------------------------
Fax | 610-670-7736
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4400 PENN AVE
-----------------------------------------------------
City | SINKING SPRING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19608-8621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-670-2522
-----------------------------------------------------
Fax | 610-670-7736
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | SP019633
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN634681
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------