Healthcare Provider Details

I. General information

NPI: 1740683077
Provider Name (Legal Business Name): RACHELLE NICOLE PACKEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 W 13 MILE RD SUITE 202
ROYAL OAK MI
48073
US

IV. Provider business mailing address

26850 PROVIDENCE PKWY STE 350
NOVI MI
48374-1261
US

V. Phone/Fax

Practice location:
  • Phone: 248-551-0900
  • Fax: 248-551-0905
Mailing address:
  • Phone: 248-662-4119
  • Fax: 248-662-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601007138
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: