Provider Demographics
NPI:1962638742
Name:WATERSON, RACHAEL E
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:E
Last Name:WATERSON
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 1:7601 HOMESTEAD RD
Mailing Address - Street 2:
Mailing Address - City:BENZONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49616-9756
Mailing Address - Country:US
Mailing Address - Phone:231-882-9802
Mailing Address - Fax:
Practice Address - Street 1:7601 HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:BENZONIA
Practice Address - State:MI
Practice Address - Zip Code:49616-9756
Practice Address - Country:US
Practice Address - Phone:231-882-9802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-07
Last Update Date:2009-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06006720390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program