Provider Demographics
NPI:1417106857
Name:BEARD, RACHAEL ANN (RN, BSN, MED)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:ANN
Last Name:BEARD
Suffix:
Gender:F
Credentials:RN, BSN, MED
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:ANN
Other - Last Name:POINTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN, MED
Mailing Address - Street 1:562 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WOOD RIVER
Mailing Address - State:IL
Mailing Address - Zip Code:62095-1708
Mailing Address - Country:US
Mailing Address - Phone:641-799-4223
Mailing Address - Fax:
Practice Address - Street 1:562 5TH ST
Practice Address - Street 2:
Practice Address - City:WOOD RIVER
Practice Address - State:IL
Practice Address - Zip Code:62095-1708
Practice Address - Country:US
Practice Address - Phone:641-799-4223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004003562163W00000X
IA117277163W00000X
IL041367969163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse