Provider Demographics
NPI:1942523451
Name:DIMEDIA, RACHELLE M (CRNA)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:M
Last Name:DIMEDIA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:RACHELLE
Other - Middle Name:
Other - Last Name:WHATMOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:190 GIBBS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2815
Mailing Address - Country:US
Mailing Address - Phone:757-746-5531
Mailing Address - Fax:
Practice Address - Street 1:795 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-1733
Practice Address - Country:US
Practice Address - Phone:508-235-5410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN258517367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered