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General NPI Number Information
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NPI Number | 1942548912
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Entity Type | Individual
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Provider Name | NICOLE RICH
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Gender | Female
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Dates
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Enumeration Date | 01/24/2013
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Last Update Date | 01/25/2013
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Provider Practice Location Address
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Address Line | 1004 LAKE HERITAGE DR
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City | RUTHER GLEN
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State | VA
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Zip | 22546-1054
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Country | US
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Telephone | 540-257-4849
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Fax |
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Provider Business Mailing Address
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Address Line | 1004 LAKE HERITAGE DR
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City | RUTHER GLEN
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State | VA
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Zip | 22546-1054
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Country | US
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Telephone | 540-257-4849
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 12386
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number | 12386
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 1401125621
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License Number State | VA
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