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General NPI Number Information
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NPI Number | 1679053193
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Entity Type | Individual
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Provider Name | RACHEL IM MSN, CRNP, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/14/2018
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Last Update Date | 08/14/2018
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Provider Practice Location Address
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Address Line | 5039 SWAMP RD STE 406
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City | FOUNTAINVILLE
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State | PA
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Zip | 18923-9665
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Country | US
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Telephone | 267-454-7147
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Fax |
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Provider Business Mailing Address
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Address Line | 1169 HILL RD
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City | LANSDALE
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State | PA
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Zip | 19446-6626
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Country | US
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Telephone |
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP019052
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License Number State | PA
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