Provider Demographics
NPI:1063940930
Name:MIVILLE, RACHEL LEAH (RN)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LEAH
Last Name:MIVILLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 THUNDERCASTLE RD
Mailing Address - Street 2:
Mailing Address - City:READFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04355-3705
Mailing Address - Country:US
Mailing Address - Phone:207-215-3982
Mailing Address - Fax:207-377-4671
Practice Address - Street 1:17 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:ME
Practice Address - Zip Code:04364-1506
Practice Address - Country:US
Practice Address - Phone:207-215-3982
Practice Address - Fax:207-377-4671
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN52948163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool