Provider Demographics
NPI:1699944389
Name:DESTITO, RACHEL RAABE (FNP BC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:RAABE
Last Name:DESTITO
Suffix:
Gender:F
Credentials:FNP BC
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:AMANDA
Other - Last Name:RAABE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:89 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX JCT
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3207
Mailing Address - Country:US
Mailing Address - Phone:802-879-6556
Mailing Address - Fax:802-872-8021
Practice Address - Street 1:89 MAIN ST
Practice Address - Street 2:
Practice Address - City:ESSEX JCT
Practice Address - State:VT
Practice Address - Zip Code:05452-3207
Practice Address - Country:US
Practice Address - Phone:802-879-6556
Practice Address - Fax:802-872-7021
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010029560363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1016247Medicaid