Provider Demographics
NPI:1922649961
Name:CORREA, RACHELLE RENEE
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:RENEE
Last Name:CORREA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 9TH ST S
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:MT
Mailing Address - Zip Code:59474-2604
Mailing Address - Country:US
Mailing Address - Phone:406-403-6674
Mailing Address - Fax:
Practice Address - Street 1:830 9TH ST S
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:MT
Practice Address - Zip Code:59474-2604
Practice Address - Country:US
Practice Address - Phone:406-403-6674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT133374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide