Provider Demographics
NPI:1326562430
Name:PRICE, RACHELLE CASSANDRA (FNP)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:CASSANDRA
Last Name:PRICE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:RACHELLE
Other - Middle Name:C
Other - Last Name:HADDOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:532 COFFEEN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2421
Mailing Address - Country:US
Mailing Address - Phone:315-782-6200
Mailing Address - Fax:
Practice Address - Street 1:532 COFFEEN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2421
Practice Address - Country:US
Practice Address - Phone:315-782-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF342104-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily