Provider Demographics
NPI:1881343895
Name:FANNING, RACHAEL M (RN)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:M
Last Name:FANNING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11631 NE 73RD ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-8107
Mailing Address - Country:US
Mailing Address - Phone:757-679-5653
Mailing Address - Fax:
Practice Address - Street 1:11631 NE 73RD ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-8107
Practice Address - Country:US
Practice Address - Phone:757-679-5653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001275657163WE0003X
CA95255916163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency