Healthcare Provider Details

I. General information

NPI: 1902090350
Provider Name (Legal Business Name): RACHAEL MARIE FERRARO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11101 N AIRPORT RD
HAYDEN ID
83835-9798
US

IV. Provider business mailing address

11101 N AIRPORT RD
HAYDEN ID
83835-9798
US

V. Phone/Fax

Practice location:
  • Phone: 208-777-5282
  • Fax:
Mailing address:
  • Phone: 208-777-5282
  • Fax: 208-213-3710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0-1194
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number60891059
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: