Provider Demographics
NPI:1851178552
Name:PETERSON, RACHEL ESTHER
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ESTHER
Last Name:PETERSON
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 1:1140 W 500 S STE 9
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2912
Mailing Address - Country:US
Mailing Address - Phone:435-789-6300
Mailing Address - Fax:435-789-6357
Practice Address - Street 1:1140 W 500 S STE 9
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2912
Practice Address - Country:US
Practice Address - Phone:435-789-6300
Practice Address - Fax:435-789-6357
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
UTF23-108555171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker