Provider Demographics
NPI:1972005056
Name:BEAUDETTE, RACHEL (CPO)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:BEAUDETTE
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 E 14TH ST STE 5
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-3240
Mailing Address - Country:US
Mailing Address - Phone:402-461-4931
Mailing Address - Fax:402-461-4932
Practice Address - Street 1:223 E 14TH ST STE 5
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3240
Practice Address - Country:US
Practice Address - Phone:402-461-4931
Practice Address - Fax:402-461-4932
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Z00000X
NE224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist