Provider Demographics
NPI:1891406203
Name:VERNON, RACHINE SALISBURY (N/A)
Entity Type:Individual
Prefix:MR
First Name:RACHINE
Middle Name:SALISBURY
Last Name:VERNON
Suffix:
Gender:M
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E MAIN AVE APT 608
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4068
Mailing Address - Country:US
Mailing Address - Phone:701-527-5999
Mailing Address - Fax:
Practice Address - Street 1:420 E MAIN AVE APT 608
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4068
Practice Address - Country:US
Practice Address - Phone:701-527-5999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider