Provider Demographics
NPI:1346599784
Name:GHOSH, RACHEL MUNDY (PPCNP-BC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MUNDY
Last Name:GHOSH
Suffix:
Gender:F
Credentials:PPCNP-BC
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:NICOLE
Other - Last Name:MUNDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PPCNP-BC
Mailing Address - Street 1:905 DEXTER AVE N
Mailing Address - Street 2:APT 509
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-3877
Mailing Address - Country:US
Mailing Address - Phone:618-971-5822
Mailing Address - Fax:
Practice Address - Street 1:1500 W 38TH ST STE 20
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6317
Practice Address - Country:US
Practice Address - Phone:512-548-5323
Practice Address - Fax:512-548-2030
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122358363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics