Healthcare Provider Details

I. General information

NPI: 1538550611
Provider Name (Legal Business Name): RACHEL ELDERSVELD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 12TH AVE NE
ROCHESTER MN
55906
US

IV. Provider business mailing address

716 12TH AVE NE
ROCHESTER MN
55906-7158
US

V. Phone/Fax

Practice location:
  • Phone: 616-498-0726
  • Fax:
Mailing address:
  • Phone: 616-498-0726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP7642
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5873
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP7642
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: