Healthcare Provider Details

I. General information

NPI: 1609623974
Provider Name (Legal Business Name): MARCIE ANN RACHAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 HOWARD HUGHES PKWY STE 300
LAS VEGAS NV
89169-0946
US

IV. Provider business mailing address

8740 PALOMINO RANCH ST
LAS VEGAS NV
89131-5247
US

V. Phone/Fax

Practice location:
  • Phone: 702-560-2192
  • Fax:
Mailing address:
  • Phone: 702-601-9065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number819601
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: