Healthcare Provider Details

I. General information

NPI: 1538600333
Provider Name (Legal Business Name): RACHEL WIXSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 OAK ST SE
SALEM OR
97301-3975
US

IV. Provider business mailing address

188 W NORTHERN LIGHTS BLVD # 100
ANCHORAGE AK
99503-3902
US

V. Phone/Fax

Practice location:
  • Phone: 503-814-2483
  • Fax:
Mailing address:
  • Phone: 907-562-2002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201701620NP-PP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number161579
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: