Healthcare Provider Details

I. General information

NPI: 1942957519
Provider Name (Legal Business Name): RACQUELLE THOMAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 S NEW ST STE 304
BETHLEHEM PA
18015-1652
US

IV. Provider business mailing address

306 S NEW ST STE 304
BETHLEHEM PA
18015-1652
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-1093
  • Fax:
Mailing address:
  • Phone: 484-347-7047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP024689
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: