Provider Demographics
NPI:1396352894
Name:SEDGEWICK, RACHEL NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:NICOLE
Last Name:SEDGEWICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-2143
Mailing Address - Country:US
Mailing Address - Phone:517-742-4922
Mailing Address - Fax:
Practice Address - Street 1:2380 CEDAR ST
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-2143
Practice Address - Country:US
Practice Address - Phone:517-742-4922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601010050207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine