Provider Demographics
NPI:1194255315
Name:RICE, CANISHA SHARRON
Entity type:Individual
Prefix:MRS
First Name:CANISHA
Middle Name:SHARRON
Last Name:RICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 CYMMER CT
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29527-3165
Mailing Address - Country:US
Mailing Address - Phone:419-407-7496
Mailing Address - Fax:
Practice Address - Street 1:1213 CYMMER CT
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29527-3165
Practice Address - Country:US
Practice Address - Phone:419-407-7496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty