Provider Demographics
NPI:1487798070
Name:DAMON, RACHEL R (NP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:R
Last Name:DAMON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4560
Mailing Address - Country:US
Mailing Address - Phone:920-926-8340
Mailing Address - Fax:920-926-8370
Practice Address - Street 1:239 TROWBRIDGE DR
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54937-9180
Practice Address - Country:US
Practice Address - Phone:920-923-7950
Practice Address - Fax:920-356-0719
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2633363LF0000X
WI2633-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2028274OtherPHYSICIANS PLUS
WI36027400Medicaid
WI61267OtherDEAN HEALTH SYSTEMS
WI61267OtherDEAN HEALTH SYSTEMS
WI2028274OtherPHYSICIANS PLUS
WIQ76381Medicare UPIN
WI543751163Medicare PIN