Provider Demographics
NPI:1538652821
Name:MANS, RACHEL M (CBD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:M
Last Name:MANS
Suffix:
Gender:F
Credentials:CBD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 NORTHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-6640
Mailing Address - Country:US
Mailing Address - Phone:618-972-4550
Mailing Address - Fax:
Practice Address - Street 1:16 NORTHWOOD AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-6640
Practice Address - Country:US
Practice Address - Phone:618-972-4550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X, 174N00000X
IL14445468RM374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174H00000XOther Service ProvidersHealth Educator
No174N00000XOther Service ProvidersLactation Consultant, Non-RN