Healthcare Provider Details

I. General information

NPI: 1932747110
Provider Name (Legal Business Name): RACHELLE GEDDES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2019
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 HARRIS AVE STE A
SACRAMENTO CA
95838-3249
US

IV. Provider business mailing address

4961 SUMMERWOOD CIR
SACRAMENTO CA
95841-2610
US

V. Phone/Fax

Practice location:
  • Phone: 916-649-6793
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number703089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: