MEDICARE: RACHEL SUNDERLIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1407507643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL SUNDERLIN

Provider Business Mailing Address
First Line	:	1562 SHADY RIDGE CT
Second Line	:
City	:	BOWLING GREEN
State	:	KY
Zip	:	42104-4717
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1562 SHADY RIDGE CT
Second Line	:
City	:	BOWLING GREEN
State	:	KY
Zip	:	42104-4717
Country	:	US
Telephone Number	:	270-779-0025
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2022
Last Update Date	:	01/10/2022

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Directions to “ RACHEL SUNDERLIN ” Practice Location

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