Provider Demographics
NPI:1912415340
Name:STIVER, RACHEL MARY GRACE (LPN)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARY GRACE
Last Name:STIVER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-3210
Mailing Address - Country:US
Mailing Address - Phone:414-312-2982
Mailing Address - Fax:
Practice Address - Street 1:916 S 10TH ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-6502
Practice Address - Country:US
Practice Address - Phone:414-312-2982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI306551164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty