Provider Demographics
NPI:1508112483
Name:HACKER, RACHEL FAWBUSH (BS,DI)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:FAWBUSH
Last Name:HACKER
Suffix:
Gender:F
Credentials:BS,DI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744-8419
Mailing Address - Country:US
Mailing Address - Phone:606-877-1065
Mailing Address - Fax:606-862-4619
Practice Address - Street 1:2212 RIVER RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40744-8419
Practice Address - Country:US
Practice Address - Phone:606-877-1065
Practice Address - Fax:606-862-4619
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor