MEDICARE: RACHEL NELSON

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	202005282RN	OR

General Provider Information

NPI Number	:	1952916678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL NELSON

Provider Business Mailing Address
First Line	:	23301 SW BOSKY DELL LN
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-9130
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	23301 SW BOSKY DELL LN
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-9130
Country	:	US
Telephone Number	:	503-989-5536
Fax Number	:

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

Provider Enumeration Date	:	09/10/2020
Last Update Date	:	09/10/2020

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