Healthcare Provider Details

I. General information

NPI: 1346929718
Provider Name (Legal Business Name): RACHAEL ZUCKETT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N NAPPANEE ST
ELKHART IN
46514-1957
US

IV. Provider business mailing address

6365 WINCHESTER BLVD STE A
CANAL WINCHESTER OH
43110-2069
US

V. Phone/Fax

Practice location:
  • Phone: 574-522-0265
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: