Provider Demographics
NPI:1841758182
Name:MATTHEWS, RACHEL RENEE (NP-BC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:RENEE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 PROSPECT PL
Mailing Address - Street 2:SUITE 340B
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118
Mailing Address - Country:US
Mailing Address - Phone:619-522-4000
Mailing Address - Fax:901-271-4187
Practice Address - Street 1:230 PROSPECT PL
Practice Address - Street 2:SUITE 340B
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118
Practice Address - Country:US
Practice Address - Phone:619-522-4000
Practice Address - Fax:901-271-4187
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177181363LF0000X
TN28663363LF0000X
CA95020743363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ063619Medicaid