Provider Demographics
NPI:1023795994
Name:PERRY, RACHELLE CATHERINE
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:CATHERINE
Last Name:PERRY
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 1:284 N PAINTED HILLS DR
Mailing Address - Street 2:
Mailing Address - City:IVINS
Mailing Address - State:UT
Mailing Address - Zip Code:84738-6081
Mailing Address - Country:US
Mailing Address - Phone:949-573-2130
Mailing Address - Fax:
Practice Address - Street 1:284 N PAINTED HILLS DR
Practice Address - Street 2:
Practice Address - City:IVINS
Practice Address - State:UT
Practice Address - Zip Code:84738-6081
Practice Address - Country:US
Practice Address - Phone:949-573-2130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9845968-4405363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care