Provider Demographics
NPI:1588835219
Name:CONNORS, RAECHEL (LPN)
Entity Type:Individual
Prefix:
First Name:RAECHEL
Middle Name:
Last Name:CONNORS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 JOE MCCARTHY DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2610
Mailing Address - Country:US
Mailing Address - Phone:518-578-0918
Mailing Address - Fax:
Practice Address - Street 1:415 JOE MCCARTHY DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2610
Practice Address - Country:US
Practice Address - Phone:518-578-0918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY289778164W00000X
VT025-0009084164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse