Provider Demographics
NPI:1407082506
Name:KHADJEHTURIAN, RACHELE ELLICE (APRN, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:RACHELE
Middle Name:ELLICE
Last Name:KHADJEHTURIAN
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:RACHELE
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:316 BISHOP PL
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-1833
Mailing Address - Country:US
Mailing Address - Phone:914-500-8183
Mailing Address - Fax:914-259-5416
Practice Address - Street 1:170 MAPLE AVE STE 309
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4714
Practice Address - Country:US
Practice Address - Phone:914-220-0283
Practice Address - Fax:914-220-0288
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335894207R00000X, 363LF0000X
CT005849363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner