MEDICARE: MS. RACHEL SUFFECOOL RN

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	RN188967	OH

General Provider Information

NPI Number	:	1568714897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RACHEL SUFFECOOL RN

Provider Business Mailing Address
First Line	:	PO BOX 7374
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44705-0374
Country	:	US
Telephone Number	:	330-312-4191
Fax Number	:

Provider Business Practice Location Address
First Line	:	2529 BOLLINGER AVE NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44705-3552
Country	:	US
Telephone Number	:	330-312-4191
Fax Number	:

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

Provider Enumeration Date	:	10/10/2012
Last Update Date	:	10/10/2012

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