Provider Demographics
NPI:1518163666
Name:NELSON, RACHEL LEONOR (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:LEONOR
Last Name:NELSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:LEONOR
Other - Last Name:HODGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1406B CRAIN HWY S STE 307
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4094
Mailing Address - Country:US
Mailing Address - Phone:703-283-2676
Mailing Address - Fax:
Practice Address - Street 1:1406B CRAIN HWY S STE 307
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4094
Practice Address - Country:US
Practice Address - Phone:703-283-2676
Practice Address - Fax:443-231-3688
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1002063363LF0000X
MDR159325363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP61568Medicare UPIN
VAP57231Medicare UPIN