MEDICARE: RAQUEL BIZZELL

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	374J00000X	Doula

General Provider Information

NPI Number	:	1689204844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAQUEL BIZZELL

Provider Business Mailing Address
First Line	:	2302 GEORGIA AVE
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-6535
Country	:	US
Telephone Number	:	561-945-2425
Fax Number	:

Provider Business Practice Location Address
First Line	:	2302 GEORGIA AVE
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-6535
Country	:	US
Telephone Number	:	561-945-2425
Fax Number	:

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

Provider Enumeration Date	:	01/16/2020
Last Update Date	:	01/16/2020

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Directions to “ RAQUEL BIZZELL ” Practice Location

Language	Start Address	Practice Location

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