Provider Demographics
NPI:1164905865
Name:ENSLEY, RACHEL (PA-C)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:ENSLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:LUCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 N WASHINGTON ST STE 8
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-2802
Mailing Address - Country:US
Mailing Address - Phone:208-813-7519
Mailing Address - Fax:208-813-7524
Practice Address - Street 1:803 S MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2695
Practice Address - Country:US
Practice Address - Phone:208-813-7519
Practice Address - Fax:208-813-7524
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-18672084N0400X
WAPA60977034363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology