Provider Demographics
NPI:1699025445
Name:RACHELS, DEBRA JEAN (LPN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JEAN
Last Name:RACHELS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:JEAN
Other - Last Name:RACHELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:14410 ROUTE 37
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62951-3166
Mailing Address - Country:US
Mailing Address - Phone:618-983-6911
Mailing Address - Fax:
Practice Address - Street 1:4241 HIGHWAY 14 WEST
Practice Address - Street 2:
Practice Address - City:CHRISTOPHER
Practice Address - State:IL
Practice Address - Zip Code:62822
Practice Address - Country:US
Practice Address - Phone:618-724-2436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043100641164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse