Healthcare Provider Details

I. General information

NPI: 1134575343
Provider Name (Legal Business Name): RACHELLE HUEMOELLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHELLE ECHIPARE NP

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S BASCOM AVE
SAN JOSE CA
95128-2604
US

IV. Provider business mailing address

3225 MCLEOD DR STE 777
LAS VEGAS NV
89121-2257
US

V. Phone/Fax

Practice location:
  • Phone: 408-793-2535
  • Fax: 408-885-3552
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number574263
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95003880
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: