Provider Demographics
NPI:1033622782
Name:ROWE, RAQUELLE G (CNM, RN)
Entity Type:Individual
Prefix:MRS
First Name:RAQUELLE
Middle Name:G
Last Name:ROWE
Suffix:
Gender:F
Credentials:CNM, RN
Other - Prefix:MS
Other - First Name:RAQUELLE
Other - Middle Name:
Other - Last Name:GRIMSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11840 NICHOLAS STREET SUITE 215
Mailing Address - Street 2:MED STAFF
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11840 NICHOLAS STREET SUITE 215
Practice Address - Street 2:MED STAFF
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154
Practice Address - Country:US
Practice Address - Phone:855-884-2360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235637176B00000X
CA704861163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No176B00000XOther Service ProvidersMidwife