Provider Demographics
NPI:1154416394
Name:PRICE, PRENTICE RAY (RN, APRN)
Entity type:Individual
Prefix:MR
First Name:PRENTICE
Middle Name:RAY
Last Name:PRICE
Suffix:
Gender:M
Credentials:RN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USAHC
Mailing Address - Street 2:UNIT 27528 BOX 49
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09139
Mailing Address - Country:US
Mailing Address - Phone:01149171-759-6125
Mailing Address - Fax:
Practice Address - Street 1:USA HEALTH CLINIC
Practice Address - Street 2:UNIT 27528
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09139
Practice Address - Country:US
Practice Address - Phone:01149951-300-8271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR134734163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator