Healthcare Provider Details

I. General information

NPI: 1417618752
Provider Name (Legal Business Name): RACHEL EMILY REDDICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2022
Last Update Date: 01/09/2022
Certification Date: 01/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 N 44TH ST APT 3113
PHOENIX AZ
85008-5744
US

IV. Provider business mailing address

1121 N 44TH ST APT 3113
PHOENIX AZ
85008-5744
US

V. Phone/Fax

Practice location:
  • Phone: 847-293-6443
  • Fax:
Mailing address:
  • Phone: 847-293-6443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number267861
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: