Healthcare Provider Details

I. General information

NPI: 1588181952
Provider Name (Legal Business Name): RACHEL MARIE OIVANTI LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S 12TH AVE W
VIRGINIA MN
55792-3099
US

IV. Provider business mailing address

505 S 12TH AVE W
VIRGINIA MN
55792-3099
US

V. Phone/Fax

Practice location:
  • Phone: 218-749-2877
  • Fax: 218-749-6033
Mailing address:
  • Phone: 218-749-2877
  • Fax: 218-749-6033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: