Healthcare Provider Details

I. General information

NPI: 1467266007
Provider Name (Legal Business Name): RACHEL MIXER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 HAMPSHIRE ST
QUINCY IL
62301-3027
US

IV. Provider business mailing address

4221 COUNTRY MEADOWS LN
QUINCY IL
62305-9504
US

V. Phone/Fax

Practice location:
  • Phone: 217-222-6550
  • Fax:
Mailing address:
  • Phone: 217-653-4697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.412238
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: