Healthcare Provider Details

I. General information

NPI: 1548201684
Provider Name (Legal Business Name): RACHEL ELEANOR WHITCOMB FNP BC, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 NORTHSIDE BLVD
SOUTH BEND IN
46615
US

IV. Provider business mailing address

1960 NORTHSIDE BLVD
SOUTH BEND IN
46615
US

V. Phone/Fax

Practice location:
  • Phone: 574-307-7673
  • Fax:
Mailing address:
  • Phone: 574-307-7673
  • Fax: 574-234-4706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number72000074A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number72000074A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: