Provider Demographics
NPI:1104607043
Name:BAEHL, RACHEL ANN
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANN
Last Name:BAEHL
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 1:10364 BUCKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:IN
Mailing Address - Zip Code:46774-7408
Mailing Address - Country:US
Mailing Address - Phone:260-432-1716
Mailing Address - Fax:
Practice Address - Street 1:10364 BUCKSHIRE CT
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:IN
Practice Address - Zip Code:46774-7408
Practice Address - Country:US
Practice Address - Phone:260-432-1716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-06
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.008674RX363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant