Healthcare Provider Details

I. General information

NPI: 1275081655
Provider Name (Legal Business Name): RACHAEL ANTONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 11/27/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W HILL BLVD
JOINT BASE CHARLESTON SC
29404-4704
US

IV. Provider business mailing address

204 W HILL BLVD
JOINT BASE CHARLESTON SC
29404-4704
US

V. Phone/Fax

Practice location:
  • Phone: 843-963-6977
  • Fax:
Mailing address:
  • Phone: 843-963-6977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number0001244626
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0024177808
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: