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General NPI Number Information
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NPI Number | 1487815742
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Entity Type | Individual
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Provider Name | RACHAEL M. BRACKE M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/19/2008
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Last Update Date | 01/29/2020
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Provider Practice Location Address
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Address Line | 3030 BIG HORN AVE
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City | CODY
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State | WY
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Zip | 82414-9208
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Country | US
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Telephone | 307-578-1955
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Fax | 307-578-1979
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Provider Business Mailing Address
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Address Line | 3030 BIG HORN AVE
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City | CODY
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State | WY
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Zip | 82414-9208
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Country | US
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Telephone | 307-578-1955
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Fax | 307-578-1979
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 29717
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 8977A
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License Number State | WY
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