Provider Demographics
NPI:1245791755
Name:NELSON, RACHEL ULLRICH (MD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ULLRICH
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:LAUREN
Other - Last Name:ULLRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7950 N PORT WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:FOX POINT
Mailing Address - State:WI
Mailing Address - Zip Code:53217-3131
Mailing Address - Country:US
Mailing Address - Phone:414-253-1194
Mailing Address - Fax:414-540-1065
Practice Address - Street 1:7950 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:FOX POINT
Practice Address - State:WI
Practice Address - Zip Code:53217-3131
Practice Address - Country:US
Practice Address - Phone:414-253-1194
Practice Address - Fax:414-540-1065
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI73833-20208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics