Provider Demographics
NPI:1003686486
Name:MYERS, RACHEL (RN)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:KOPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4457 18TH ST S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-7189
Mailing Address - Country:US
Mailing Address - Phone:612-210-5112
Mailing Address - Fax:
Practice Address - Street 1:1720 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4940
Practice Address - Country:US
Practice Address - Phone:701-234-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR47816163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse