Provider Demographics
NPI:1467705558
Name:WU, RACHEL
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KUANYI
Other - Middle Name:
Other - Last Name:WU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:1049 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103
Mailing Address - Country:US
Mailing Address - Phone:413-739-1100
Mailing Address - Fax:413-735-1133
Practice Address - Street 1:1049 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103
Practice Address - Country:US
Practice Address - Phone:413-739-1100
Practice Address - Fax:413-735-1133
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5197363L00000X
MARN2291684363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
1467705558OtherNPI#
MA110028120Medicaid
MAMW0954102IOtherCONTROLLED SUBSTANCE REGISTRATION
DCMW2780840OtherDEA-CONTROLLED SUBSTANCE REGISTRATION
MAMW0954102IOtherCONTROLLED SUBSTANCE REGISTRATION
MAS400156870Medicare UPIN
MA221829Medicare Oscar/Certification