Provider Demographics
NPI:1558696773
Name:BONCZEK, RACHEL E (CPNP-AC/PC)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:E
Last Name:BONCZEK
Suffix:
Gender:F
Credentials:CPNP-AC/PC
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:E
Other - Last Name:BONCZEK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPNP - AC/PC
Mailing Address - Street 1:6621 FANNIN STREET
Mailing Address - Street 2:TEXAS CHILDREN'S HOSPITAL EMERGENCY CENTER
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:832-227-1000
Mailing Address - Fax:
Practice Address - Street 1:6621 FANNIN STREET
Practice Address - Street 2:TEXAS CHILDREN'S HOSPITAL EMERGENCY CENTER
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:832-227-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127147363LP0200X
DCRN1025865363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX341534101Medicaid
TX341534101Medicaid