Provider Demographics
NPI:1710450978
Name:RENDON, RAQUEL (CHW)
Entity Type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:
Last Name:RENDON
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 731
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-0731
Mailing Address - Country:US
Mailing Address - Phone:507-646-8964
Mailing Address - Fax:507-322-4003
Practice Address - Street 1:710 DIVISION ST S
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2484
Practice Address - Country:US
Practice Address - Phone:507-646-8964
Practice Address - Fax:507-322-4003
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker