Provider Demographics
NPI:1255694204
Name:RECORE, RACHEL LYNN (WHNP)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:LYNN
Last Name:RECORE
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22567 SUMMIT DR STE A
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-7233
Mailing Address - Country:US
Mailing Address - Phone:315-782-7230
Mailing Address - Fax:
Practice Address - Street 1:22567 SUMMIT DR STE A
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-7233
Practice Address - Country:US
Practice Address - Phone:315-782-7230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-23
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704378411363LW0102X
NY421081363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03593744Medicaid