Healthcare Provider Details

I. General information

NPI: 1518749464
Provider Name (Legal Business Name): RACHEL ROSE PRATT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4971 BEAR RD
LIVERPOOL NY
13088-4156
US

IV. Provider business mailing address

4971 BEAR RD
LIVERPOOL NY
13088-4156
US

V. Phone/Fax

Practice location:
  • Phone: 315-451-9509
  • Fax:
Mailing address:
  • Phone: 315-451-9509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF352205-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberF352205-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: