Provider Demographics
NPI:1699942581
Name:RACHEL NESS M.D., PLLC
Entity type:Organization
Organization Name:RACHEL NESS M.D., PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:NESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-478-8780
Mailing Address - Street 1:3173 43RD STREET S STE A
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4564
Mailing Address - Country:US
Mailing Address - Phone:701-478-8780
Mailing Address - Fax:701-478-8781
Practice Address - Street 1:3173 43RD STREET S STE A
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4564
Practice Address - Country:US
Practice Address - Phone:701-478-8780
Practice Address - Fax:701-478-8781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-11
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND9784207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14772Medicaid
NDI21978Medicare UPIN
ND14772Medicaid