Provider Demographics
NPI:1609276575
Name:DEROUIN, RACHELLE ROCHELLE (NP)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:ROCHELLE
Last Name:DEROUIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28985 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-3652
Mailing Address - Country:US
Mailing Address - Phone:586-321-1069
Mailing Address - Fax:
Practice Address - Street 1:28985 PINEHURST DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-3652
Practice Address - Country:US
Practice Address - Phone:586-321-1069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704244302163WC0200X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine