Provider Demographics
NPI:1750144895
Name:SQUIBB, RACHEL LYNN
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNN
Last Name:SQUIBB
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 1:3025 NEWARK DR E
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53090-8624
Mailing Address - Country:US
Mailing Address - Phone:414-551-7991
Mailing Address - Fax:
Practice Address - Street 1:W 175 N 1117 STONEWOOD DR
Practice Address - Street 2:UNIT 100
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022
Practice Address - Country:US
Practice Address - Phone:262-293-3951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI232538-30163WM0705X
WI15203-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical