MEDICARE: MS. RACHEL WADDELL

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	163W00000X	Registered Nurse	1159727	AL
2	163W00000X	Registered Nurse	11597	AL

General Provider Information

NPI Number	:	1881230068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RACHEL WADDELL

Provider Business Mailing Address
First Line	:	3545 GRANDVIEW PKWY APT 228
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35243-2079
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3545 GRANDVIEW PKWY APT 228
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35243-2079
Country	:	US
Telephone Number	:	205-903-6999
Fax Number	:

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

Provider Enumeration Date	:	11/21/2019
Last Update Date	:	11/21/2019

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