Healthcare Provider Details

I. General information

NPI: 1932842192
Provider Name (Legal Business Name): RACHEL HENDERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2022
Last Update Date: 04/15/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10831 N THORP HWY
THORP WA
98946-9600
US

IV. Provider business mailing address

PO BOX 476
CLE ELUM WA
98922-0476
US

V. Phone/Fax

Practice location:
  • Phone: 509-964-2107
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN00177383
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: