Provider Demographics
NPI:1013366616
Name:VANWORMER, RACHEL (NP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:VANWORMER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:ROE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1360 N SAINT HELEN RD
Mailing Address - Street 2:PO BOX 39
Mailing Address - City:SAINT HELEN
Mailing Address - State:MI
Mailing Address - Zip Code:48656-9521
Mailing Address - Country:US
Mailing Address - Phone:989-826-3271
Mailing Address - Fax:
Practice Address - Street 1:1360 N SAINT HELEN RD
Practice Address - Street 2:
Practice Address - City:SAINT HELEN
Practice Address - State:MI
Practice Address - Zip Code:48656-9521
Practice Address - Country:US
Practice Address - Phone:989-826-3271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704267157363LF0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse