Healthcare Provider Details

I. General information

NPI: 1477210656
Provider Name (Legal Business Name): RACHEL MAE MCDONALD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL MAE HOLLAND NP

II. Dates (important events)

Enumeration Date: 11/22/2021
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 W MAIN ST
NORWICH CT
06360-6056
US

IV. Provider business mailing address

607 W MAIN ST
NORWICH CT
06360-6056
US

V. Phone/Fax

Practice location:
  • Phone: 860-650-3848
  • Fax:
Mailing address:
  • Phone: 860-892-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14643
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: