Provider Demographics
NPI:1144243833
Name:TOLLEFSRUD, RACHEL L (MD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:L
Last Name:TOLLEFSRUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:L
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:502 2ND ST SW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-3365
Mailing Address - Country:US
Mailing Address - Phone:320-235-7232
Mailing Address - Fax:320-231-8609
Practice Address - Street 1:502 2ND ST SW
Practice Address - Street 2:SUITE 1
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3365
Practice Address - Country:US
Practice Address - Phone:320-235-7232
Practice Address - Fax:320-231-8609
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN135201OtherUCARE
MNP00245103OtherRR MEDICARE
MN749418100Medicaid
MN2378456OtherARAZ
MN325101845OtherPRIME WEST
MNHP55084OtherHEALTH PARTNERS
MN354G6GROtherBLUE CROSS BLUE SHIELD
MN01-21830OtherMEDICA
MNMR1081044146OtherPREFERRED ONE
MNHP55084OtherHEALTH PARTNERS
MN749418100Medicaid