Provider Demographics
NPI:1821548355
Name:JABR, RACHEL
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:JABR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E POPE ST
Mailing Address - Street 2:APT 6
Mailing Address - City:GOLCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:62938-1057
Mailing Address - Country:US
Mailing Address - Phone:618-924-3093
Mailing Address - Fax:
Practice Address - Street 1:115 E POPE ST
Practice Address - Street 2:APT 6
Practice Address - City:GOLCONDA
Practice Address - State:IL
Practice Address - Zip Code:62938-1057
Practice Address - Country:US
Practice Address - Phone:618-924-3093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILJ16072565644172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver