Provider Demographics
NPI:1699719914
Name:BARTLETT, RACHAEL S (PA)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:S
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:S
Other - Last Name:STADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1414 W. FAIR AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855
Mailing Address - Country:US
Mailing Address - Phone:906-225-4500
Mailing Address - Fax:906-225-3919
Practice Address - Street 1:1414 W. FAIR AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855
Practice Address - Country:US
Practice Address - Phone:906-225-4500
Practice Address - Fax:906-225-3919
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004556363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP026560002Medicare ID - Type Unspecified
MIE26038018Medicare PIN