Provider Demographics
NPI:1417534637
Name:RIEL, RACHEL L (PA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:L
Last Name:RIEL
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 1:594 ALEX CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3725
Mailing Address - Country:US
Mailing Address - Phone:254-744-0736
Mailing Address - Fax:
Practice Address - Street 1:601 STATE ROUTE 664 N
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-8541
Practice Address - Country:US
Practice Address - Phone:740-380-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006872RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant