Provider Demographics
NPI:1699480012
Name:WILT, RACHAEL LYNN (RN)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:LYNN
Last Name:WILT
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 1:30190 W CRITTENDEN LN
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-7344
Mailing Address - Country:US
Mailing Address - Phone:623-703-2417
Mailing Address - Fax:
Practice Address - Street 1:38201 W INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:TONOPAH
Practice Address - State:AZ
Practice Address - Zip Code:85354-8671
Practice Address - Country:US
Practice Address - Phone:623-474-5385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ238380163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse