Provider Demographics
NPI:1184008682
Name:VIETOR, RACHELE (PA-C)
Entity Type:Individual
Prefix:
First Name:RACHELE
Middle Name:
Last Name:VIETOR
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:PO BOX 49
Mailing Address - Street 2:161 SOUTH MAIN
Mailing Address - City:MISSION
Mailing Address - State:SD
Mailing Address - Zip Code:57555
Mailing Address - Country:US
Mailing Address - Phone:605-856-2295
Mailing Address - Fax:605-856-2755
Practice Address - Street 1:161 SOUTH MAIN
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:SD
Practice Address - Zip Code:57555-0001
Practice Address - Country:US
Practice Address - Phone:605-856-2295
Practice Address - Fax:605-856-2275
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant