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General NPI Number Information
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NPI Number | 1164905865
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Entity Type | Individual
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Provider Name | RACHEL ENSLEY PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/10/2018
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 803 S MAIN ST STE 110
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City | MOSCOW
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State | ID
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Zip | 83843-2695
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Country | US
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Telephone | 208-813-7519
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Fax | 208-813-7524
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Provider Business Mailing Address
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Address Line | 111 N WASHINGTON ST STE 8
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City | MOSCOW
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State | ID
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Zip | 83843-2802
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Country | US
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Telephone | 208-813-7519
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Fax | 208-813-7524
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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