Healthcare Provider Details

I. General information

NPI: 1487385852
Provider Name (Legal Business Name): RACHAEL WARNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 E 73RD ST APT GF
NEW YORK NY
10021-3555
US

IV. Provider business mailing address

346 MONTFORD AVE APT 18
ASHEVILLE NC
28801-1047
US

V. Phone/Fax

Practice location:
  • Phone: 917-362-8641
  • Fax:
Mailing address:
  • Phone: 917-362-9641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZA2600X
TaxonomyMedical Art Specialist/Technologist
License Number50089846
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: