Provider Demographics
NPI:1740814896
Name:VANDEMARK, RACHEL CECILE
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:CECILE
Last Name:VANDEMARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 JOURNEY ST SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98513-6779
Mailing Address - Country:US
Mailing Address - Phone:360-459-5312
Mailing Address - Fax:
Practice Address - Street 1:4840 JOURNEY ST SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98513-6779
Practice Address - Country:US
Practice Address - Phone:360-459-5312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61297705363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics