Provider Demographics
NPI:1063692002
Name:CARGILL, RACHEL E (LMP)
Entity type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:E
Last Name:CARGILL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4007 BRIDGEPORT WAY W
Mailing Address - Street 2:SUITE F-1
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4330
Mailing Address - Country:US
Mailing Address - Phone:253-565-7529
Mailing Address - Fax:253-399-2508
Practice Address - Street 1:4007 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE F-1
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4330
Practice Address - Country:US
Practice Address - Phone:253-565-7529
Practice Address - Fax:253-399-2508
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022880174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist