Provider Demographics
NPI:1841185444
Name:FRY, RACHEL LEA (RN)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LEA
Last Name:FRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:LEA
Other - Last Name:WADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:860 17TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2610
Mailing Address - Country:US
Mailing Address - Phone:319-325-6449
Mailing Address - Fax:319-325-6449
Practice Address - Street 1:860 17TH ST SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2610
Practice Address - Country:US
Practice Address - Phone:319-391-0073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079078163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty