Provider Demographics
NPI:1255832200
Name:MBA, RACHEAL
Entity Type:Individual
Prefix:
First Name:RACHEAL
Middle Name:
Last Name:MBA
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 1:9186 FOREST LN APT 125
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-8947
Mailing Address - Country:US
Mailing Address - Phone:713-449-6505
Mailing Address - Fax:
Practice Address - Street 1:9519 FOREST LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-5901
Practice Address - Country:US
Practice Address - Phone:469-407-8697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX905780163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse