Provider Demographics
NPI:1588898407
Name:ROUDEBUSH, RACHEL A (RN)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:A
Last Name:ROUDEBUSH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 DUNMORE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-1004
Mailing Address - Country:US
Mailing Address - Phone:330-837-7663
Mailing Address - Fax:
Practice Address - Street 1:3325 DUNMORE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-1004
Practice Address - Country:US
Practice Address - Phone:330-837-7663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN286101163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health