Provider Demographics
NPI:1922632140
Name:MINTON, RACHAEL (RN)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:MINTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:MATASCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:718 NW 86TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-7742
Mailing Address - Country:US
Mailing Address - Phone:360-921-0226
Mailing Address - Fax:
Practice Address - Street 1:6221 NE FOURTH PLAIN BLVD STE A
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7206
Practice Address - Country:US
Practice Address - Phone:360-989-3743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60628545163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)