Provider Demographics
NPI:1457509580
Name:COLON, RACHEL SUDELA
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:SUDELA
Last Name:COLON
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 1:763 E HIGHWAY 80
Mailing Address - Street 2:130
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-8676
Mailing Address - Country:US
Mailing Address - Phone:972-564-0050
Mailing Address - Fax:972-564-2138
Practice Address - Street 1:763 E HIGHWAY 80
Practice Address - Street 2:130
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-8676
Practice Address - Country:US
Practice Address - Phone:972-564-0050
Practice Address - Fax:972-564-2138
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCOL104338401363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology