Provider Demographics
NPI:1447902184
Name:GREGG, RACHAEL MARIE (RN)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:MARIE
Last Name:GREGG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:MARIE
Other - Last Name:PIXLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6408 PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:MI
Mailing Address - Zip Code:49268-9789
Mailing Address - Country:US
Mailing Address - Phone:517-442-5199
Mailing Address - Fax:
Practice Address - Street 1:30 HUNTER LN
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2400
Practice Address - Country:US
Practice Address - Phone:800-748-3243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704255352163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse