Provider Demographics
NPI:1609892678
Name:WEBSTER, RACHELLE R (PA-C)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:R
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RACHELLE
Other - Middle Name:R
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:16059 E OTERO PL
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4601
Mailing Address - Country:US
Mailing Address - Phone:303-400-3836
Mailing Address - Fax:
Practice Address - Street 1:7030 S YOSEMITE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2026
Practice Address - Country:US
Practice Address - Phone:303-721-9984
Practice Address - Fax:303-996-3278
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1368363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COQ44225Medicare UPIN
COC801914Medicare PIN