Provider Demographics
NPI:1205166121
Name:YOUNGBLOOD, RACHAEL ELIZABETH (CRNP)
Entity type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:ELIZABETH
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:ELIZABETH
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:409 S 2ND ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2005 TECHNOLOGY PKWY
Practice Address - Street 2:SUITE 440
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-9413
Practice Address - Country:US
Practice Address - Phone:717-791-2540
Practice Address - Fax:717-791-2549
Is Sole Proprietor?:No
Enumeration Date:2009-12-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010606363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103010353Medicaid
PA173204Medicare PIN