Provider Demographics
NPI:1497111488
Name:VINES, RACHAEL (CNA)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:VINES
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19627 BRADY
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-1364
Mailing Address - Country:US
Mailing Address - Phone:734-890-8781
Mailing Address - Fax:
Practice Address - Street 1:19627 BRADY
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-1364
Practice Address - Country:US
Practice Address - Phone:734-890-8781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI238924830596376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide