Provider Demographics
NPI:1972954600
Name:ANGULO, RACHEL (MNSC, APRN, CPNP-PC)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:ANGULO
Suffix:
Gender:F
Credentials:MNSC, APRN, CPNP-PC
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:MONTANEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:3101 SE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-4900
Mailing Address - Country:US
Mailing Address - Phone:479-636-9234
Mailing Address - Fax:
Practice Address - Street 1:3101 SE 14TH ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4900
Practice Address - Country:US
Practice Address - Phone:479-636-9234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004773363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics