Provider Demographics
NPI:1710339957
Name:ROSSI, RACHAL L (APN)
Entity Type:Individual
Prefix:
First Name:RACHAL
Middle Name:L
Last Name:ROSSI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:RACHAL
Other - Middle Name:L
Other - Last Name:WALDSCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1850 E 53RD ST STE 2
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2784
Mailing Address - Country:US
Mailing Address - Phone:563-359-4106
Mailing Address - Fax:
Practice Address - Street 1:1850 E 53RD ST STE 2
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2784
Practice Address - Country:US
Practice Address - Phone:563-359-4106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-014457363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner