Provider Demographics
NPI:1932580966
Name:GATTUSO, RACHEL MILLER (NPP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MILLER
Last Name:GATTUSO
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6836 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1024
Mailing Address - Country:US
Mailing Address - Phone:315-446-1435
Mailing Address - Fax:315-446-4269
Practice Address - Street 1:6836 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1024
Practice Address - Country:US
Practice Address - Phone:315-446-1435
Practice Address - Fax:315-446-4269
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401839363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health