Basic Information
| Provider Information | |||||||||
| NPI: | 1780898320 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICE | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | WHCNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45 MARTIN LN | ||||||||
| Address2: | |||||||||
| City: | SPRINGBORO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450667459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377482254 | ||||||||
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| Practice Location | |||||||||
| Address1: | 420 SUPERIOR ST | ||||||||
| Address2: | |||||||||
| City: | SANDUSKY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196265623 | ||||||||
| FaxNumber: | 4196268778 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 07/18/2018 | ||||||||
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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 | 207VG0400X | NP00743 | OH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | RIC104303878 | 01 | OH | WOMENS HEALTH PRACTIONER | OTHER |