Provider Demographics
NPI:1154851921
Name:MAXWELL, RACHEL ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANN
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2979 SQUALICUM PKWY STE 203
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1813
Mailing Address - Country:US
Mailing Address - Phone:360-733-7670
Mailing Address - Fax:360-647-1901
Practice Address - Street 1:2979 SQUALICUM PKWY STE 203
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1813
Practice Address - Country:US
Practice Address - Phone:360-733-7670
Practice Address - Fax:360-647-1901
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059022363A00000X
WAPA61265495363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2206904Medicaid
WA471274OtherWA LABOR & INDUSTRIES