Healthcare Provider Details

I. General information

NPI: 1679937510
Provider Name (Legal Business Name): RACHAEL LAUREN RODIMEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHAEL LAUREN RAYMOND

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 ST FRANCIS WAY STE 100
LAFAYETTE IN
47905-4917
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 765-428-5990
  • Fax: 765-428-5896
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28204289A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71006751A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number71006751A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: