Provider Demographics
NPI:1346285202
Name:BURGETT, RACHEL L (ARNP)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:L
Last Name:BURGETT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1586
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366
Mailing Address - Country:US
Mailing Address - Phone:360-871-2800
Mailing Address - Fax:360-871-2800
Practice Address - Street 1:7926 PROMENADE LANE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367
Practice Address - Country:US
Practice Address - Phone:360-871-2800
Practice Address - Fax:360-871-2800
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004799363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB05865Medicare ID - Type Unspecified
8854807Medicare UPIN