Provider Demographics
NPI:1588317937
Name:RICE, VICTORIA R
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:R
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 1:74 N FISHER PARK WAY
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-4704
Mailing Address - Country:US
Mailing Address - Phone:208-391-7210
Mailing Address - Fax:
Practice Address - Street 1:74 N FISHER PARK WAY
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-4704
Practice Address - Country:US
Practice Address - Phone:208-391-7210
Practice Address - Fax:208-391-2130
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-2636363A00000X, 363A00000X
CA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical