Provider Demographics
NPI:1942924576
Name:NEWHOUSE, RACHEL (PAC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:NEWHOUSE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2527 CHESTNUT HILLS DR APT 301
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-2044
Mailing Address - Country:US
Mailing Address - Phone:616-312-5334
Mailing Address - Fax:
Practice Address - Street 1:601 JOHN ST STE 100
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5317
Practice Address - Country:US
Practice Address - Phone:269-373-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601011251363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant