Provider Demographics
NPI:1790263457
Name:RAGHUNANDAN, RACHAEL L (FNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:RACHAEL
Middle Name:L
Last Name:RAGHUNANDAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3295 SW AVALON WAY APT 601
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-2791
Mailing Address - Country:US
Mailing Address - Phone:305-282-2235
Mailing Address - Fax:
Practice Address - Street 1:317 NE THORNTON PL STE 10A&10
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-8020
Practice Address - Country:US
Practice Address - Phone:206-673-4620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60872404363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily