Provider Demographics
NPI:1437301587
Name:WHITESIDE, RACHAEL SUZANNE (RN)
Entity Type:Individual
Prefix:MS
First Name:RACHAEL
Middle Name:SUZANNE
Last Name:WHITESIDE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 S LENZNER AVE
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-4880
Mailing Address - Country:US
Mailing Address - Phone:520-515-2930
Mailing Address - Fax:
Practice Address - Street 1:1045 S LENZNER AVE
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-4880
Practice Address - Country:US
Practice Address - Phone:520-515-2930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN140671163W00000X
AZSN0988163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163W00000XNursing Service ProvidersRegistered Nurse