Provider Demographics
NPI:1740683077
Name:PACKEY, RACHELLE NICOLE (PA-C)
Entity type:Individual
Prefix:MS
First Name:RACHELLE
Middle Name:NICOLE
Last Name:PACKEY
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:26850 PROVIDENCE PKWY STE 350
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1261
Mailing Address - Country:US
Mailing Address - Phone:248-662-4119
Mailing Address - Fax:248-662-4120
Practice Address - Street 1:3535 W 13 MILE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073
Practice Address - Country:US
Practice Address - Phone:248-551-0900
Practice Address - Fax:248-551-0905
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2023-12-20
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Provider Licenses
StateLicense IDTaxonomies
MI5601007138363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant