Provider Demographics
NPI:1770561011
Name:BURGER, RACHAEL R (PAC)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:R
Last Name:BURGER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2435
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68848-2435
Mailing Address - Country:US
Mailing Address - Phone:308-234-5520
Mailing Address - Fax:308-236-6590
Practice Address - Street 1:3219 CENTRAL AVE
Practice Address - Street 2:STE 110
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847
Practice Address - Country:US
Practice Address - Phone:308-234-5520
Practice Address - Fax:308-236-6590
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1134363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
277480Medicare ID - Type Unspecified
Q15144Medicare UPIN