Healthcare Provider Details

I. General information

NPI: 1467053553
Provider Name (Legal Business Name): RACHEL RT WYBRON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 S VAL VISTA DR BLDG 15 STE 185
GILBERT AZ
85295
US

IV. Provider business mailing address

2680 S VAL VISTA DR BLDG 15 STE 185
GILBERT AZ
85295
US

V. Phone/Fax

Practice location:
  • Phone: 480-630-4434
  • Fax:
Mailing address:
  • Phone: 480-630-4434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN210167
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number258930
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: