Provider Demographics
NPI:1508268368
Name:HOUSEAL, RACHEL MICHELLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:MICHELLE
Last Name:HOUSEAL
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 1:0401 CASTLE CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611
Mailing Address - Country:US
Mailing Address - Phone:970-279-4111
Mailing Address - Fax:970-927-3915
Practice Address - Street 1:0401 CASTLE CREEK ROAD
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611
Practice Address - Country:US
Practice Address - Phone:970-279-4111
Practice Address - Fax:970-927-3915
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081355363A00000X
COPA.0004186363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08820872Medicaid