Provider Demographics
NPI:1225541584
Name:EDDIE, RACHELLE DANA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:RACHELLE
Middle Name:DANA
Last Name:EDDIE
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 1:12880 THREE MAN TRL
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-3004
Mailing Address - Country:US
Mailing Address - Phone:928-707-0878
Mailing Address - Fax:
Practice Address - Street 1:12880 THREE MAN TRL
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-3004
Practice Address - Country:US
Practice Address - Phone:928-707-0878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6867363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical