Provider Demographics
NPI:1245750579
Name:GATHONJIA, RACHAEL W
Entity Type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:W
Last Name:GATHONJIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 N LARKIN AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3454
Mailing Address - Country:US
Mailing Address - Phone:815-714-2271
Mailing Address - Fax:
Practice Address - Street 1:815 N LARKIN AVE STE 105
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-3454
Practice Address - Country:US
Practice Address - Phone:815-714-2271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.015384363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily