Provider Demographics
NPI:1356376693
Name:ZICKL, RACHEL M (FNP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:M
Last Name:ZICKL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 TOUNTAS AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482
Mailing Address - Country:US
Mailing Address - Phone:585-768-4400
Mailing Address - Fax:585-768-7792
Practice Address - Street 1:701 SENECA ST STE 646C
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14210-1351
Practice Address - Country:US
Practice Address - Phone:716-995-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
0406844OtherINDEPENDENT HEALTH
102906BJOtherPREFERRED CARE
00010009201OtherUNIVERA
NY005605341OtherBCBS WNY
NYP010000065OtherBCBS ROCHESTER
NY000560534001OtherCOMMUNITY BLUE