Provider Demographics
NPI:1073931143
Name:TRUMP, RACHAEL
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:TRUMP
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 1:3297 TRIPLECROWN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OH
Mailing Address - Zip Code:45052-9712
Mailing Address - Country:US
Mailing Address - Phone:513-602-6167
Mailing Address - Fax:
Practice Address - Street 1:3297 TRIPLECROWN DR
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OH
Practice Address - Zip Code:45052-9712
Practice Address - Country:US
Practice Address - Phone:513-602-6167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH235077291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory