Basic Information
| Provider Information | |||||||||
| NPI: | 1184047797 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICE | ||||||||
| FirstName: | COLLEEN | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10800 WILL PAINTER DR | ||||||||
| Address2: | |||||||||
| City: | OWINGS MILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211175124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4432433747 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7505 OSLER DR STE 104 | ||||||||
| Address2: | |||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212047737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103378888 | ||||||||
| FaxNumber: | 4108234833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2014 | ||||||||
| LastUpdateDate: | 03/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | C0005317 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | C0005317 | 01 | MD | PA-C LICENSE | OTHER |