Provider Demographics
NPI:1386768299
Name:KRISHNA, RACHANA (M D)
Entity type:Individual
Prefix:DR
First Name:RACHANA
Middle Name:
Last Name:KRISHNA
Suffix:
Gender:F
Credentials:M D
Other - Prefix:DR
Other - First Name:RACHANA
Other - Middle Name:
Other - Last Name:K
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M D
Mailing Address - Street 1:5100 PRAIRIE PKWY
Mailing Address - Street 2:STE 203
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-8155
Mailing Address - Country:US
Mailing Address - Phone:319-222-2903
Mailing Address - Fax:319-222-2993
Practice Address - Street 1:5100 PRAIRIE PKWY
Practice Address - Street 2:STE 203
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-8155
Practice Address - Country:US
Practice Address - Phone:319-222-2903
Practice Address - Fax:319-222-2993
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083716208000000X
IA37060208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA076372Medicaid
IA57920OtherWELLMARK
IA076372Medicaid