Provider Demographics
NPI: | 1639894967 |
---|---|
Name: | RACHEL LISLE WELLNESS |
Entity Type: | Organization |
Organization Name: | RACHEL LISLE WELLNESS |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OFFICE MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | HUNTER |
Authorized Official - Middle Name: | WALTON |
Authorized Official - Last Name: | LISLE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 972-922-6167 |
Mailing Address - Street 1: | 4020 N MACARTHUR BLVD STE 122 PMB 1110 |
Mailing Address - Street 2: | |
Mailing Address - City: | IRVING |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75038 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 972-922-6167 |
Mailing Address - Fax: | 888-858-6905 |
Practice Address - Street 1: | 4020 N MACARTHUR BLVD STE 122 PMB 1110 |
Practice Address - Street 2: | |
Practice Address - City: | IRVING |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75038 |
Practice Address - Country: | US |
Practice Address - Phone: | 972-922-6167 |
Practice Address - Fax: | 888-858-6905 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-10-10 |
Last Update Date: | 2022-10-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |