Provider Demographics
NPI:1265901755
Name:WALTHER, RACHEL S (PA-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:S
Last Name:WALTHER
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:13320 CRANE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-1083
Mailing Address - Country:US
Mailing Address - Phone:248-534-3807
Mailing Address - Fax:
Practice Address - Street 1:4660 S HAGADORN RD STE 600
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5383
Practice Address - Country:US
Practice Address - Phone:517-267-2460
Practice Address - Fax:517-884-8602
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-14
Last Update Date:2024-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601009412363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant