Provider Demographics
NPI:1891027702
Name:NUSCHKE, RACHAEL CRITTENDEN (FNP)
Entity Type:Individual
Prefix:MS
First Name:RACHAEL
Middle Name:CRITTENDEN
Last Name:NUSCHKE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:RACHAEL
Other - Middle Name:CRITTENDEN
Other - Last Name:DEDEAUX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:4500 13TH ST
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2569
Mailing Address - Country:US
Mailing Address - Phone:228-867-4000
Mailing Address - Fax:
Practice Address - Street 1:179 DRINKWATER RD
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-1613
Practice Address - Country:US
Practice Address - Phone:228-575-2929
Practice Address - Fax:228-467-4337
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR867573363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily