Provider Demographics
NPI:1225013410
Name:RICE, DENNIS R (LPN)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:R
Last Name:RICE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 2ND AVE
Mailing Address - Street 2:APT #3
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2627
Mailing Address - Country:US
Mailing Address - Phone:801-521-6039
Mailing Address - Fax:
Practice Address - Street 1:2472 S 300 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-2895
Practice Address - Country:US
Practice Address - Phone:801-415-7426
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT166218-3101164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107029324101OtherINTERMOUNTAIN HEALTH CARE
UT107029324101OtherINTERMOUNTAIN HEALTH CARE