Provider Demographics
NPI:1720675671
Name:GETZLAFF, RACHAEL LEIGH (RN)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:LEIGH
Last Name:GETZLAFF
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3696 VICTOR LN
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-6500
Mailing Address - Country:US
Mailing Address - Phone:714-334-5246
Mailing Address - Fax:
Practice Address - Street 1:12024 LAMEY BRIDGE RD
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-8906
Practice Address - Country:US
Practice Address - Phone:228-396-2858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-27
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID60352163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse