Provider Demographics
NPI:1881410801
Name:MILAM, RACHELLE (RN)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:MILAM
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 1:4200 BRIDGEVIEW DR APT 816
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-5533
Mailing Address - Country:US
Mailing Address - Phone:469-655-4448
Mailing Address - Fax:
Practice Address - Street 1:4200 BRIDGEVIEW DR APT 816
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-5533
Practice Address - Country:US
Practice Address - Phone:469-655-4448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX922019163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse