Healthcare Provider Details

I. General information

NPI: 1780446120
Provider Name (Legal Business Name): RACHEL D'URSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W SIMPSON STREET
ALLIANCE OH
44601
US

IV. Provider business mailing address

420 W SIMPSON STREET
ALLIANCE OH
44601
US

V. Phone/Fax

Practice location:
  • Phone: 800-992-6682
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: