Provider Demographics
NPI:1225313075
Name:NORTH, RACHAEL MARIE (LPN)
Entity Type:Individual
Prefix:MS
First Name:RACHAEL
Middle Name:MARIE
Last Name:NORTH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 STEELE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-1609
Mailing Address - Country:US
Mailing Address - Phone:937-371-2030
Mailing Address - Fax:
Practice Address - Street 1:823 STEELE AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45410-1609
Practice Address - Country:US
Practice Address - Phone:937-371-2030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH153407164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2905119Medicaid