Provider Demographics
NPI:1336856616
Name:BAXTER, RACHELLE A (RN)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:A
Last Name:BAXTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:LEVAN
Mailing Address - State:UT
Mailing Address - Zip Code:84639-0597
Mailing Address - Country:US
Mailing Address - Phone:435-660-1079
Mailing Address - Fax:
Practice Address - Street 1:144 E 100 N
Practice Address - Street 2:
Practice Address - City:LEVAN
Practice Address - State:UT
Practice Address - Zip Code:84639-0597
Practice Address - Country:US
Practice Address - Phone:435-660-1079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT347157-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse