Provider Demographics
NPI:1396461166
Name:WILSON, RACHELLE (ND)
Entity type:Individual
Prefix:DR
First Name:RACHELLE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:ND
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 483
Mailing Address - Street 2:
Mailing Address - City:SPRINGTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:76082-0483
Mailing Address - Country:US
Mailing Address - Phone:817-881-7135
Mailing Address - Fax:
Practice Address - Street 1:1034 LAND OF GOSHEN DR
Practice Address - Street 2:
Practice Address - City:SPRINGTOWN
Practice Address - State:TX
Practice Address - Zip Code:76082-5752
Practice Address - Country:US
Practice Address - Phone:817-881-7135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath