Healthcare Provider Details

I. General information

NPI: 1497045439
Provider Name (Legal Business Name): RACHELLE HUTCHINSON R.N., CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHELLE GARDNER R.N., CRNA

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 02/11/2022
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LAWRENCE EXPY
SANTA CLARA CA
95051-5173
US

IV. Provider business mailing address

14495 PFEIFER DR
LAKE OSWEGO OR
97035-2412
US

V. Phone/Fax

Practice location:
  • Phone: 707-695-8491
  • Fax:
Mailing address:
  • Phone: 707-695-8491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number653794
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: