Provider Demographics
NPI:1003139759
Name:MYERS, RACHEAL JADE (LPN)
Entity Type:Individual
Prefix:
First Name:RACHEAL
Middle Name:JADE
Last Name:MYERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:DRYDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13053-9752
Mailing Address - Country:US
Mailing Address - Phone:607-592-1316
Mailing Address - Fax:
Practice Address - Street 1:249 LAKE RD
Practice Address - Street 2:
Practice Address - City:DRYDEN
Practice Address - State:NY
Practice Address - Zip Code:13053-9752
Practice Address - Country:US
Practice Address - Phone:607-342-4061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300490164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse