Provider Demographics
NPI:1063272904
Name:RAVNAAS, RACHELLE SAMANTHA
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:SAMANTHA
Last Name:RAVNAAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1652 21ST ST NW
Mailing Address - Street 2:
Mailing Address - City:TURTLE LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58575-9681
Mailing Address - Country:US
Mailing Address - Phone:701-315-0014
Mailing Address - Fax:
Practice Address - Street 1:1652 21ST ST NW
Practice Address - Street 2:
Practice Address - City:TURTLE LAKE
Practice Address - State:ND
Practice Address - Zip Code:58575-9681
Practice Address - Country:US
Practice Address - Phone:701-315-0014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No374U00000XNursing Service Related ProvidersHome Health Aide