MEDICARE: RACHEL KIDDER 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	9507239	FL
2	163W00000X	Registered Nurse	723018	NY

General Provider Information

NPI Number	:	1922640234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL KIDDER RN

Provider Business Mailing Address
First Line	:	2478 BRITNEY LAKES LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32221-3816
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2478 BRITNEY LAKES LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32221-3816
Country	:	US
Telephone Number	:	716-969-7055
Fax Number	:

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

Provider Enumeration Date	:	10/09/2019
Last Update Date	:	10/09/2019

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Directions to “ RACHEL KIDDER RN” Practice Location

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