Provider Demographics
NPI:1982110722
Name:BLEA, RACHAEL LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:LYNN
Last Name:BLEA
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 27420
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2026
Mailing Address - Country:US
Mailing Address - Phone:586-216-7423
Mailing Address - Fax:248-327-1261
Practice Address - Street 1:12660 TEN MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-9141
Practice Address - Country:US
Practice Address - Phone:248-348-1131
Practice Address - Fax:248-348-1171
Is Sole Proprietor?:No
Enumeration Date:2017-12-15
Last Update Date:2021-09-28
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Provider Licenses
StateLicense IDTaxonomies
CO0005225363AM0700X
MI5601010532363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical