Provider Demographics
NPI:1578371548
Name:CAPONE, RACHELLE (CHW)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:CAPONE
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 SE DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-3317
Mailing Address - Country:US
Mailing Address - Phone:541-440-6283
Mailing Address - Fax:
Practice Address - Street 1:1036 SE DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3317
Practice Address - Country:US
Practice Address - Phone:541-440-6283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4369172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker