Healthcare Provider Details

I. General information

NPI: 1821349937
Provider Name (Legal Business Name): MRS. RACHEL KELLY VAN BUREN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2012
Last Update Date: 09/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3124 SHENANDOAH AVE
CHARLOTTE NC
28205-6945
US

IV. Provider business mailing address

3124 SHENANDOAH AVE
CHARLOTTE NC
28205-6945
US

V. Phone/Fax

Practice location:
  • Phone: 704-819-6495
  • Fax:
Mailing address:
  • Phone: 704-819-6495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: