Healthcare Provider Details

I. General information

NPI: 1558932640
Provider Name (Legal Business Name): RACHAEL WUEST PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 E ROOSEVELT RD STE 105
WEST CHICAGO IL
60185-3969
US

IV. Provider business mailing address

480 E ROOSEVELT RD STE 105
WEST CHICAGO IL
60185-3969
US

V. Phone/Fax

Practice location:
  • Phone: 630-492-1965
  • Fax:
Mailing address:
  • Phone: 630-492-1965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-008631
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: