Provider Demographics
NPI:1841673738
Name:PERSON, RACHEL R (APRN)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:R
Last Name:PERSON
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 1:12910 PIERCE ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-1105
Mailing Address - Country:US
Mailing Address - Phone:402-933-3770
Mailing Address - Fax:402-933-3633
Practice Address - Street 1:12910 PIERCE ST STE 120
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-1106
Practice Address - Country:US
Practice Address - Phone:402-933-3770
Practice Address - Fax:402-933-3633
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA143690207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026411700Medicaid
IA1841673738Medicaid