Provider Demographics
NPI:1013720077
Name:GIFFHORN, RACHEL C (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:C
Last Name:GIFFHORN
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6422 OLE STILL DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-2561
Mailing Address - Country:US
Mailing Address - Phone:314-448-2080
Mailing Address - Fax:
Practice Address - Street 1:12860 TROXLER AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-2898
Practice Address - Country:US
Practice Address - Phone:618-651-2810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-31
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025002107363LP0808X
IL209031663363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health