Provider Demographics
NPI:1700553542
Name:IRWIN, RACHEL DIANE (FNP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:DIANE
Last Name:IRWIN
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 1:2330 S DIXON RD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-6411
Mailing Address - Country:US
Mailing Address - Phone:765-455-5400
Mailing Address - Fax:765-865-3710
Practice Address - Street 1:2330 S DIXON RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-6411
Practice Address - Country:US
Practice Address - Phone:765-455-5400
Practice Address - Fax:765-865-3710
Is Sole Proprietor?:No
Enumeration Date:2021-08-28
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71011495A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily