Healthcare Provider Details

I. General information

NPI: 1184498420
Provider Name (Legal Business Name): RACHEL LAUREN KIDDER MLS(ASCP)CM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3682 S PERTH CIR UNIT 104
AURORA CO
80013-7509
US

IV. Provider business mailing address

3682 S PERTH CIR UNIT 104
AURORA CO
80013-7509
US

V. Phone/Fax

Practice location:
  • Phone: 574-312-4237
  • Fax:
Mailing address:
  • Phone: 574-312-4237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number264490
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: