Provider Demographics
NPI:1508541202
Name:YORK, RACHEL MACKENZIE (PA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MACKENZIE
Last Name:YORK
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:MACKENZIE
Other - Last Name:DANIELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 E WABASHA ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55803-1850
Mailing Address - Country:US
Mailing Address - Phone:262-685-7587
Mailing Address - Fax:
Practice Address - Street 1:413 29TH ST NE STE I
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-7154
Practice Address - Country:US
Practice Address - Phone:855-255-1750
Practice Address - Fax:855-255-0905
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAPA61676080363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program