Provider Demographics
NPI:1851960702
Name:BIRGE, RACHAEL (APRN)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:BIRGE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 WATERFRONT PARKWAY EAST DR STE 370
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-2069
Mailing Address - Country:US
Mailing Address - Phone:317-978-0257
Mailing Address - Fax:317-974-9077
Practice Address - Street 1:2611 WATERFRONT PARKWAY EAST DR STE 370
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-2069
Practice Address - Country:US
Practice Address - Phone:317-978-0257
Practice Address - Fax:317-974-9077
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71011234A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health