Provider Demographics
NPI:1669748034
Name:CLOUTIER, RACHEL (NP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:CLOUTIER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7202 GLEN FOREST DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3781
Mailing Address - Country:US
Mailing Address - Phone:804-673-0134
Mailing Address - Fax:804-673-1796
Practice Address - Street 1:7501 RIGHT FLANK RD
Practice Address - Street 2:SUITE 600
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-3863
Practice Address - Country:US
Practice Address - Phone:804-559-2489
Practice Address - Fax:804-730-5847
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169964363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC01120OtherMEDICARE GROUP PTAN
VAVV6657AMedicare PIN