Provider Demographics
NPI:1376015032
Name:VERCNOCKE, RACHEL MARIE
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:MARIE
Last Name:VERCNOCKE
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 1:9100 SCHULTZ RD
Mailing Address - Street 2:
Mailing Address - City:HERRON
Mailing Address - State:MI
Mailing Address - Zip Code:49744-9750
Mailing Address - Country:US
Mailing Address - Phone:989-245-7633
Mailing Address - Fax:
Practice Address - Street 1:MIDMICHIGAN HOME CARE
Practice Address - Street 2:1521 W. CHISHOLM STREET
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707
Practice Address - Country:US
Practice Address - Phone:989-356-8004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015956225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist