Provider Demographics
NPI:1841016748
Name:WIENECKE, RACHELE (FNP)
Entity type:Individual
Prefix:MRS
First Name:RACHELE
Middle Name:
Last Name:WIENECKE
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:RACHELE
Other - Middle Name:
Other - Last Name:HINTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4509 E 112TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64137-2444
Mailing Address - Country:US
Mailing Address - Phone:941-524-4542
Mailing Address - Fax:
Practice Address - Street 1:4509 E 112TH TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64137-2444
Practice Address - Country:US
Practice Address - Phone:941-524-4542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018024783163W00000X
MO2025007917363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse