Provider Demographics
NPI:1548208234
Name:WAGNER, RACHEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:M
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:M
Other - Last Name:WANNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:873 HINOTES CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-9043
Mailing Address - Country:US
Mailing Address - Phone:360-318-9705
Mailing Address - Fax:360-318-8735
Practice Address - Street 1:2220 CORNWALL AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-3719
Practice Address - Country:US
Practice Address - Phone:360-752-2865
Practice Address - Fax:360-647-8093
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045321207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8436636Medicaid
WA8926939OtherLABOR & INDUSTRIES (CV)
WA0201489OtherLABOR & INDUSTRIES (REG)
WA3970WAOtherREGENCE BLUESHIELD
WA0201489OtherLABOR & INDUSTRIES (REG)
WAI42915Medicare UPIN