Provider Demographics
NPI:1427645332
Name:KING, RACHELLE DEANNE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:DEANNE
Last Name:KING
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20831 CRESTVIEW LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-5951
Mailing Address - Country:US
Mailing Address - Phone:949-394-3136
Mailing Address - Fax:
Practice Address - Street 1:20831 CRESTVIEW LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-5951
Practice Address - Country:US
Practice Address - Phone:949-394-3136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-26
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95070439163WM0102X, 163WW0101X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory