Provider Demographics
NPI:1033661160
Name:GRENFELL-DEXTER, RACHAEL
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:GRENFELL-DEXTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 3RD ST
Mailing Address - Street 2:APT 2L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2981
Mailing Address - Country:US
Mailing Address - Phone:615-800-9005
Mailing Address - Fax:
Practice Address - Street 1:453 3RD ST
Practice Address - Street 2:APT 2L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2981
Practice Address - Country:US
Practice Address - Phone:615-800-9005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY431072363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care