Healthcare Provider Details

I. General information

NPI: 1174701338
Provider Name (Legal Business Name): JESSICA ECHEVERRIA RAABE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2008
Last Update Date: 02/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3071 FLAMINGO DR
DECATUR GA
30033-3930
US

IV. Provider business mailing address

3071 FLAMINGO DR
DECATUR GA
30033-3930
US

V. Phone/Fax

Practice location:
  • Phone: 404-323-4541
  • Fax:
Mailing address:
  • Phone: 404-323-4541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN168211
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: