Healthcare Provider Details

I. General information

NPI: 1609429307
Provider Name (Legal Business Name): RACHELLE EYRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 BOX BUTTE AVE
ALLIANCE NE
69301-4445
US

IV. Provider business mailing address

PO BOX 882014
STEAMBOAT SPRINGS CO
80488-2014
US

V. Phone/Fax

Practice location:
  • Phone: 308-762-6660
  • Fax:
Mailing address:
  • Phone: 970-903-2838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1017259
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number112884
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: