Provider Demographics
NPI:1497983092
Name:ANDERSON, RACHEL LEMAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:LEMAN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 AMERICAN AVENUE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188
Mailing Address - Country:US
Mailing Address - Phone:262-549-2229
Mailing Address - Fax:262-549-1657
Practice Address - Street 1:721 AMERICAN AVENUE
Practice Address - Street 2:SUITE 304
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188
Practice Address - Country:US
Practice Address - Phone:262-549-2229
Practice Address - Fax:262-549-1657
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003914363AM0700X
WI2440-23363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
12006221OtherCAQH
WI1497983092Medicaid
ML1979826OtherDEA
12006221OtherCAQH