Provider Demographics
NPI:1962281675
Name:ODEI-KWATIA, RACHEAL NAAMUA (NP)
Entity type:Individual
Prefix:MRS
First Name:RACHEAL
Middle Name:NAAMUA
Last Name:ODEI-KWATIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:RACHEAL
Other - Middle Name:NAAMUA
Other - Last Name:ODEI KWATIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:6 CALVERT CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-1839
Mailing Address - Country:US
Mailing Address - Phone:571-409-8262
Mailing Address - Fax:
Practice Address - Street 1:1101 SAM PERRY BLVD STE 207
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4465
Practice Address - Country:US
Practice Address - Phone:540-741-4350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024188261363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care