Provider Demographics
NPI:1336297860
Name:PRANGER, RACHEL B (PA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:B
Last Name:PRANGER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 MORGAN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-1430
Mailing Address - Country:US
Mailing Address - Phone:217-854-3881
Mailing Address - Fax:217-854-3894
Practice Address - Street 1:1115 MORGAN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-1430
Practice Address - Country:US
Practice Address - Phone:217-854-3881
Practice Address - Fax:217-854-3894
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003016368-MO363AM0700X
IL085000924363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO561349OtherHEALTHLINK
MO561349OtherHEALTHLINK
MO000097061Medicare PIN