Provider Demographics
NPI:1497897003
Name:HAMELL, RACHELLE J (NP)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:J
Last Name:HAMELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-381-2222
Mailing Address - Fax:
Practice Address - Street 1:214 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:RIGGINS
Practice Address - State:ID
Practice Address - Zip Code:83549
Practice Address - Country:US
Practice Address - Phone:208-628-3666
Practice Address - Fax:208-634-7212
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP380A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010149379OtherBS PLMC
IDNPLH0OtherBC SRMC
IDNPQG7OtherBC PLMC
ID000010017403OtherBS SRMC
ID805158000Medicaid
ID500018433OtherRRMCR
ID1342091Medicare PIN
IDS67498Medicare UPIN