Provider Demographics
NPI:1578091054
Name:PARKER, RACHELLE LYNN
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:LYNN
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 MADISON ST STE 307
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6665
Mailing Address - Country:US
Mailing Address - Phone:630-789-3422
Mailing Address - Fax:
Practice Address - Street 1:301 MADISON ST STE 307
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6665
Practice Address - Country:US
Practice Address - Phone:630-789-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014482363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209014482OtherSTATE LICENSE