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General NPI Number Information
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NPI Number | 1578031241
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Entity Type | Individual
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Provider Name | RACHEL ANNE DEFAUW PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/10/2018
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Last Update Date | 04/03/2024
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Provider Practice Location Address
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Address Line | 2237 REDLANDS PKWY
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City | GRAND JUNCTION
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State | CO
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Zip | 81507-1101
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Country | US
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Telephone | 970-858-9894
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Fax | 970-858-1331
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Provider Business Mailing Address
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Address Line | PO BOX 130
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City | FRUITA
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State | CO
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Zip | 81521-0130
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Country | US
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Telephone | 970-858-2186
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Fax | 970-858-2208
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | PA.0005623
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0005623
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License Number State | CO
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