Healthcare Provider Details

I. General information

NPI: 1629098165
Provider Name (Legal Business Name): RACHEAL WUNSCH RN, FNP-C, ACHPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 E LOCUST AVE
VICTORIA TX
77901-3933
US

IV. Provider business mailing address

110 ARABIAN DR
VICTORIA TX
77904-3248
US

V. Phone/Fax

Practice location:
  • Phone: 361-572-4300
  • Fax: 361-570-0908
Mailing address:
  • Phone: 361-580-1650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number648385
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: