Provider Demographics
NPI:1891443289
Name:DEMATTEI, RACHAEL (APRN)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:DEMATTEI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:SCHAEFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 25228
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62525-5228
Mailing Address - Country:US
Mailing Address - Phone:217-329-3232
Mailing Address - Fax:217-233-1670
Practice Address - Street 1:321 REGENCY PARK STE 100
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1887
Practice Address - Country:US
Practice Address - Phone:618-416-7970
Practice Address - Fax:618-416-7971
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041495134163W00000X
MO2017003138163W00000X
IL209027937363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse