Provider Demographics
NPI:1891751285
Name:CIESLEWICZ, RACHEL L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:L
Last Name:CIESLEWICZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 REGIONAL MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-9719
Mailing Address - Country:US
Mailing Address - Phone:979-532-1700
Mailing Address - Fax:979-532-4584
Practice Address - Street 1:2520 B F TERRY BLVD
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-5636
Practice Address - Country:US
Practice Address - Phone:281-342-6006
Practice Address - Fax:281-239-7554
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02539363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX970028617OtherRAILROAD GBA - RAILROAD MEDICARE
TXP01090440OtherRAILROAD MEDICARE PTAN
TX306204402Medicaid
TX875N28OtherBC/BS #
TX875N28OtherBC/BS #
TXD12784Medicare UPIN
TXTXB157038Medicare PIN