Healthcare Provider Details

I. General information

NPI: 1982986782
Provider Name (Legal Business Name): RACHELLE MORRIS RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

07 CHOOSHGAI DRIVE TOHATCHI HEALTH CENTER -
TOHATCHI NM
87325
US

IV. Provider business mailing address

P.O. BOX 1337
GALLUP NM
87305-1337
US

V. Phone/Fax

Practice location:
  • Phone: 505-733-8400
  • Fax: 505-733-8239
Mailing address:
  • Phone: 505-733-8400
  • Fax: 505-733-8239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR46072
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: