Provider Demographics
NPI:1588219455
Name:GIETZEN, RACHELLE ARIELE (MD)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:ARIELE
Last Name:GIETZEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10810 EXECUTIVE CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4386
Mailing Address - Country:US
Mailing Address - Phone:501-604-2695
Mailing Address - Fax:
Practice Address - Street 1:10810 EXECUTIVE CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-4386
Practice Address - Country:US
Practice Address - Phone:501-604-2695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10067750207ZP0102X
ARE-16150207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology