Healthcare Provider Details

I. General information

NPI: 1164994455
Provider Name (Legal Business Name): RACHEL MARIE CUSHMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2018
Last Update Date: 12/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8410 W THOMAS RD STE 134
PHOENIX AZ
85037-3374
US

IV. Provider business mailing address

915 E VALENCIA DR
PHOENIX AZ
85042-6600
US

V. Phone/Fax

Practice location:
  • Phone: 623-907-2377
  • Fax:
Mailing address:
  • Phone: 602-820-7866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7323
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: