Provider Demographics
NPI:1528796430
Name:KLUG, RACHEL
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:KLUG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1584 180TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NE
Mailing Address - Zip Code:68743-3062
Mailing Address - Country:US
Mailing Address - Phone:712-898-1405
Mailing Address - Fax:
Practice Address - Street 1:1021 NEBRASKA ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51105-1436
Practice Address - Country:US
Practice Address - Phone:712-252-2477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA170196363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily