MEDICARE: DR. RACHEL ANNE PRUDHOMME DNP, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	4704309686	MI
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4704309686	MI

General Provider Information

NPI Number	:	1487045753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RACHEL ANNE PRUDHOMME DNP, PMHNP-BC

Provider Business Mailing Address
First Line	:	22234 220TH AVE
Second Line	:
City	:	PARIS
State	:	MI
Zip	:	49338-9455
Country	:	US
Telephone Number	:	231-742-0117
Fax Number	:

Provider Business Practice Location Address
First Line	:	2730 5 MILE RD NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-6518
Country	:	US
Telephone Number	:	616-426-9401
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2015
Last Update Date	:	11/10/2022

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