Provider Demographics
NPI:1326889072
Name:VINCENT, RACHEL ELAINE (NP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ELAINE
Last Name:VINCENT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1023 ELLSMERE ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-3738
Mailing Address - Country:US
Mailing Address - Phone:616-902-1562
Mailing Address - Fax:
Practice Address - Street 1:1023 ELLSMERE ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-3738
Practice Address - Country:US
Practice Address - Phone:616-902-1562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704279200363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner