Provider Demographics
NPI:1225514722
Name:DULANEY, RACHEL (FNP-C)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:DULANEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2059 FAIRFIELD PL APT 3
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7260
Mailing Address - Country:US
Mailing Address - Phone:618-560-9177
Mailing Address - Fax:
Practice Address - Street 1:1405 N GREEN MOUNT RD STE 240
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-3494
Practice Address - Country:US
Practice Address - Phone:618-632-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018016871363LF0000X
IL209017864363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily