Provider Demographics
NPI:1255118196
Name:PORTER, RACHEL (FNP-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:GALLEGOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 E PENROSE AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-0246
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8181 N CORNERSTONE DR
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8752
Practice Address - Country:US
Practice Address - Phone:078-520-8772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID66465363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily