Basic Information
Provider Information
NPI: 1982060463
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RICE
FirstName: RACHEL
MiddleName: COPPERSMITH
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
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OtherLastNameType:  
Mailing Information
Address1: 2421 SILVER STREAM LN
Address2:  
City: WILMINGTON
State: NC
PostalCode: 284017684
CountryCode: US
TelephoneNumber: 9103413300
FaxNumber: 9102512067
Practice Location
Address1: 2421 SILVER STREAM LN
Address2:  
City: WILMINGTON
State: NC
PostalCode: 284017684
CountryCode: US
TelephoneNumber: 9103413300
FaxNumber: 9102512067
Other Information
ProviderEnumerationDate: 01/13/2016
LastUpdateDate: 06/04/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/04/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X001006153NCY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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