Provider Demographics
NPI:1871548511
Name:STICE, RITA COLEEN (MD)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:COLEEN
Last Name:STICE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17030 LAKESIDE HILLS PLAZA
Mailing Address - Street 2:# 214
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130
Mailing Address - Country:US
Mailing Address - Phone:402-758-5500
Mailing Address - Fax:402-758-5510
Practice Address - Street 1:17030 LAKESIDE HILLS PLAZA
Practice Address - Street 2:# 214
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130
Practice Address - Country:US
Practice Address - Phone:402-758-5500
Practice Address - Fax:402-758-5510
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE169502086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47076982013Medicaid
NE263153001Medicare PIN
D09074Medicare UPIN