Provider Demographics
NPI:1265174122
Name:POLINES, RACHEL JOY
Entity type:Individual
Prefix:
First Name:RACHEL JOY
Middle Name:
Last Name:POLINES
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 1:5100 N 6TH ST STE 157
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7506
Mailing Address - Country:US
Mailing Address - Phone:559-293-3155
Mailing Address - Fax:559-293-3143
Practice Address - Street 1:5100 N 6TH ST STE 157
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7506
Practice Address - Country:US
Practice Address - Phone:559-293-3155
Practice Address - Fax:559-293-3143
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95020475363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care