Provider Demographics
NPI:1033423322
Name:DEKKER, RACHAEL R (CNP, CRNA)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:R
Last Name:DEKKER
Suffix:
Gender:F
Credentials:CNP, CRNA
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:R
Other - Last Name:BURGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNP
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1018 6TH AVE
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187
Practice Address - Country:US
Practice Address - Phone:605-321-3069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000604363LW0102X
SDCR000907367500000X
MN1941367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health