Provider Demographics
NPI:1891424115
Name:HUGHESDON, RACHEL LYNN (RN)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNN
Last Name:HUGHESDON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 W FERNEY ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48815-9776
Mailing Address - Country:US
Mailing Address - Phone:734-890-2098
Mailing Address - Fax:
Practice Address - Street 1:240 W FERNEY ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48815-9776
Practice Address - Country:US
Practice Address - Phone:734-890-2098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704390166163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704390166OtherRN LICENSE