Healthcare Provider Details

I. General information

NPI: 1295071223
Provider Name (Legal Business Name): MRS. RACHEL S SAWYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2012
Last Update Date: 07/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 WADSWORTH DR
NORTH CHESTERFIELD VA
23236
US

IV. Provider business mailing address

107 WADSWORTH DR
NORTH CHESTERFIELD VA
23236-4521
US

V. Phone/Fax

Practice location:
  • Phone: 804-560-9852
  • Fax: 804-330-4126
Mailing address:
  • Phone: 804-330-4021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110004142
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: