Healthcare Provider Details

I. General information

NPI: 1457079006
Provider Name (Legal Business Name): RACHEL CLOW CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 08/19/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 N WEST ST
OLNEY IL
62450-1160
US

IV. Provider business mailing address

1004 E SOUTH AVE
OLNEY IL
62450-2956
US

V. Phone/Fax

Practice location:
  • Phone: 618-392-9400
  • Fax:
Mailing address:
  • Phone: 618-204-7585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number209025762
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: