Provider Demographics
NPI:1942844485
Name:ATIS, RACHEL DAMASO (APRN)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:DAMASO
Last Name:ATIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 BUENA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-7804
Mailing Address - Country:US
Mailing Address - Phone:214-801-0195
Mailing Address - Fax:
Practice Address - Street 1:5500 SOUTHWESTERN MEDICAL AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7299
Practice Address - Country:US
Practice Address - Phone:214-801-0195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142656363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily