Provider Demographics
NPI:1679232268
Name:EDEN, RACHEL PAIGE
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:PAIGE
Last Name:EDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NOKOMIS
Other - Middle Name:
Other - Last Name:EDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1361 S BROOK ST APT 1
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-2070
Mailing Address - Country:US
Mailing Address - Phone:270-333-9969
Mailing Address - Fax:
Practice Address - Street 1:1361 S BROOK ST APT 1
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-2070
Practice Address - Country:US
Practice Address - Phone:270-333-9969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-11
Last Update Date:2021-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay