Healthcare Provider Details

I. General information

NPI: 1528778305
Provider Name (Legal Business Name): RACHELLE BREDY LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHELLE ALEXANDRE LPN

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 NICHOLS ST
NORWOOD MA
02062-2009
US

IV. Provider business mailing address

1 EISENHOWER DR
RANDOLPH MA
02368-3842
US

V. Phone/Fax

Practice location:
  • Phone: 781-762-0858
  • Fax:
Mailing address:
  • Phone: 781-856-4690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLN68720
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: