Provider Demographics
NPI:1699417709
Name:PETERSON, RACHAEL ANN (BSN, RN)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:ANN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E 4TH ST STE 7
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-4061
Mailing Address - Country:US
Mailing Address - Phone:307-299-9477
Mailing Address - Fax:855-679-9725
Practice Address - Street 1:801 E 4TH ST STE 7
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-4061
Practice Address - Country:US
Practice Address - Phone:307-299-9477
Practice Address - Fax:855-679-9725
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-09
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X, 376J00000X
WY41550163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker