Healthcare Provider Details

I. General information

NPI: 1376877662
Provider Name (Legal Business Name): RACHEL DRAKE MSN,RN,MS,RD, PNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHEL GLENNON

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 HIGH ST
MIDDLETOWN CT
06457-2633
US

IV. Provider business mailing address

414 HIGH ST
MIDDLETOWN CT
06457-2633
US

V. Phone/Fax

Practice location:
  • Phone: 860-759-3733
  • Fax:
Mailing address:
  • Phone: 860-759-3733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number12210
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number917
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number183740
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: