Healthcare Provider Details

I. General information

NPI: 1366930992
Provider Name (Legal Business Name): RACHELE BEAUDOIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3823 PREACHER RD
JASPER NY
14855-9758
US

IV. Provider business mailing address

3823 PREACHER RD
JASPER NY
14855-9758
US

V. Phone/Fax

Practice location:
  • Phone: 513-907-3343
  • Fax:
Mailing address:
  • Phone: 513-907-3343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number710913-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: