Provider Demographics
NPI:1922736131
Name:RIZZO, RACHAEL (PNP-PC)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:RIZZO
Suffix:
Gender:F
Credentials:PNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2337 FAIRBURY
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-1622
Mailing Address - Country:US
Mailing Address - Phone:734-626-7344
Mailing Address - Fax:
Practice Address - Street 1:1125 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4073
Practice Address - Country:US
Practice Address - Phone:810-230-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704348994208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4704348994OtherBOARD OF NURSING