Provider Demographics
NPI:1124994231
Name:BOURGEOIS, RACHEL LEIGH ANN
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LEIGH ANN
Last Name:BOURGEOIS
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 1:402 SAND ST APT A
Mailing Address - Street 2:
Mailing Address - City:RAVENSWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26164-1626
Mailing Address - Country:US
Mailing Address - Phone:304-514-1718
Mailing Address - Fax:
Practice Address - Street 1:402 SAND ST APT A
Practice Address - Street 2:
Practice Address - City:RAVENSWOOD
Practice Address - State:WV
Practice Address - Zip Code:26164-1626
Practice Address - Country:US
Practice Address - Phone:304-514-1718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant