Provider Demographics
NPI:1508824087
Name:MEIROSE, RACHEL ANNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ANNE
Last Name:MEIROSE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ANNE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:214 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SACKETS HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:13685
Mailing Address - Country:US
Mailing Address - Phone:717-729-6650
Mailing Address - Fax:
Practice Address - Street 1:T-27 N. LEWIS AVE.
Practice Address - Street 2:USA MEDDAC
Practice Address - City:FORT DRUM
Practice Address - State:NY
Practice Address - Zip Code:13602-5004
Practice Address - Country:US
Practice Address - Phone:315-772-9947
Practice Address - Fax:315-772-9929
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013077-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P81785Medicare UPIN
PA070710JJVMedicare ID - Type Unspecified