Provider Demographics
NPI:1629409412
Name:WALTZ, RACHEL (RN)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:WALTZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1272 STATE ROUTE 96
Mailing Address - Street 2:
Mailing Address - City:PHELPS
Mailing Address - State:NY
Mailing Address - Zip Code:14532-9550
Mailing Address - Country:US
Mailing Address - Phone:315-719-9621
Mailing Address - Fax:
Practice Address - Street 1:1272 STATE ROUTE 96
Practice Address - Street 2:
Practice Address - City:PHELPS
Practice Address - State:NY
Practice Address - Zip Code:14532-9550
Practice Address - Country:US
Practice Address - Phone:315-719-9621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY648480-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse