Provider Demographics
NPI:1962654673
Name:JARAMILLO, RACHELLE ALICE (PA-C)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:ALICE
Last Name:JARAMILLO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:GLENNS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83623-0266
Mailing Address - Country:US
Mailing Address - Phone:208-366-7416
Mailing Address - Fax:208-366-2595
Practice Address - Street 1:486 W FIRST ST
Practice Address - Street 2:
Practice Address - City:GLENNS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83623-0266
Practice Address - Country:US
Practice Address - Phone:208-366-7416
Practice Address - Fax:208-366-2595
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-771363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical