Healthcare Provider Details

I. General information

NPI: 1245377977
Provider Name (Legal Business Name): RACHELLE W RODRIGUEZ RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4039 US HIGHWAY 93 N STE C
STEVENSVILLE MT
59870-6482
US

IV. Provider business mailing address

PO BOX 695
STEVENSVILLE MT
59870-0695
US

V. Phone/Fax

Practice location:
  • Phone: 406-241-2977
  • Fax: 833-973-5102
Mailing address:
  • Phone: 406-241-2977
  • Fax: 833-973-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP16943
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number239262
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN588315
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number239047
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: