Provider Demographics
NPI:1750445854
Name:RACHEK, THERESA (APRN)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:RACHEK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3421
Mailing Address - Country:US
Mailing Address - Phone:508-771-8114
Mailing Address - Fax:508-771-5822
Practice Address - Street 1:687 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3421
Practice Address - Country:US
Practice Address - Phone:508-771-8114
Practice Address - Fax:508-771-5822
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003369363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care