Provider Demographics
NPI:1134476435
Name:LARRIEUX, RACHELLE
Entity Type:Individual
Prefix:MS
First Name:RACHELLE
Middle Name:
Last Name:LARRIEUX
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:RACHELLE
Other - Middle Name:
Other - Last Name:BALOGUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:123 DEPEW AVENUE
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960
Mailing Address - Country:US
Mailing Address - Phone:845-675-7705
Mailing Address - Fax:
Practice Address - Street 1:123 DEPEW AVENUE
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960
Practice Address - Country:US
Practice Address - Phone:845-675-7705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299656164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse