Provider Demographics
NPI:1235973710
Name:JACQUES, RACHELE' (PHLEBOTOMIST AND MED)
Entity type:Individual
Prefix:
First Name:RACHELE'
Middle Name:
Last Name:JACQUES
Suffix:
Gender:F
Credentials:PHLEBOTOMIST AND MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7089 N CALDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-1032
Mailing Address - Country:US
Mailing Address - Phone:847-410-7252
Mailing Address - Fax:847-410-7256
Practice Address - Street 1:7089 N CALDWELL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-1032
Practice Address - Country:US
Practice Address - Phone:847-410-7252
Practice Address - Fax:847-410-7256
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
IL246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other