Provider Demographics
NPI:1871894766
Name:PERRETTA, RACHEL JO (MS, RN, ACNS-BC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:JO
Last Name:PERRETTA
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Gender:F
Credentials:MS, RN, ACNS-BC
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Mailing Address - Street 1:6680 POE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-2855
Mailing Address - Country:US
Mailing Address - Phone:937-280-8400
Mailing Address - Fax:937-245-6308
Practice Address - Street 1:2350 MIAMI VALLEY DR STE 500
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4780
Practice Address - Country:US
Practice Address - Phone:937-293-1622
Practice Address - Fax:937-245-6308
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2022-01-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH11945364SA2200X
OHRN.3017COA.11945-NS364SA2200X
OHAPRN.CNS.11945364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3111591Medicaid