Basic Information
Provider Information
NPI: 1518367861
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DEMELLO RICE
FirstName: RACHEL
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 5074
Address2:  
City: SIOUX FALLS
State: SD
PostalCode: 571175074
CountryCode: US
TelephoneNumber: 7014400717
FaxNumber:  
Practice Location
Address1: 222 N 7TH ST
Address2:  
City: BISMARCK
State: ND
PostalCode: 585014436
CountryCode: US
TelephoneNumber: 7015307000
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/23/2014
LastUpdateDate: 02/12/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/12/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XR33366NDY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


Home