Healthcare Provider Details

I. General information

NPI: 1033632351
Provider Name (Legal Business Name): RACHAEL B CONNOR CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 07/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

9635 ELROD RD
KENSINGTON MD
20895-3116
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-6492
  • Fax: 202-476-3623
Mailing address:
  • Phone: 301-942-6322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRN63108
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: