Provider Demographics
NPI:1750874566
Name:VANNATTAN, RACHEL
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:VANNATTAN
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 1:120 NIX RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ASH FLAT
Mailing Address - State:AR
Mailing Address - Zip Code:72513-9017
Mailing Address - Country:US
Mailing Address - Phone:870-307-5209
Mailing Address - Fax:
Practice Address - Street 1:120 NIX RIDGE RD
Practice Address - Street 2:
Practice Address - City:ASH FLAT
Practice Address - State:AR
Practice Address - Zip Code:72513-9017
Practice Address - Country:US
Practice Address - Phone:870-307-5209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty