Healthcare Provider Details

I. General information

NPI: 1851164925
Provider Name (Legal Business Name): RACHELE MARIE MISSELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 S TRIMBLE RD
MANSFIELD OH
44906-3427
US

IV. Provider business mailing address

1025 S TRIMBLE RD
MANSFIELD OH
44906-3427
US

V. Phone/Fax

Practice location:
  • Phone: 419-529-4602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number412303
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: