Healthcare Provider Details

I. General information

NPI: 1174145189
Provider Name (Legal Business Name): RACHAEL ANN WARREN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 S DAISY ST
SALMON ID
83467-4709
US

IV. Provider business mailing address

2009 NE 117TH ST
VANCOUVER WA
98686-4022
US

V. Phone/Fax

Practice location:
  • Phone: 208-756-5600
  • Fax:
Mailing address:
  • Phone: 360-566-9112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number71618
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: