Provider Demographics
NPI:1548201684
Name:WHITCOMB, RACHEL ELEANOR (FNP BC, CNM)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ELEANOR
Last Name:WHITCOMB
Suffix:
Gender:F
Credentials:FNP BC, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 NORTHSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615
Mailing Address - Country:US
Mailing Address - Phone:574-307-7673
Mailing Address - Fax:574-234-4706
Practice Address - Street 1:1960 NORTHSIDE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615
Practice Address - Country:US
Practice Address - Phone:574-307-7673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN72000074A367A00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000577788OtherBCBS
IN200398660Medicaid
IN200398660Medicaid
IN168060SMedicaid
IN200398660Medicare ID - Type Unspecified