1568637619 NPI number — MRS. RACHELLE RAE GUSE MASTERS

Table of content: MRS. RACHELLE RAE GUSE MASTERS (NPI 1568637619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568637619 NPI number — MRS. RACHELLE RAE GUSE MASTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUSE
Provider First Name:
RACHELLE
Provider Middle Name:
RAE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MASTERS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568637619
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
N5589 COMMERCE RD
Provider Second Line Business Mailing Address:
SUITE 170A
Provider Business Mailing Address City Name:
ONALASKA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54650-9266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-474-0966
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
N5589 COMMERCE RD
Provider Second Line Business Practice Location Address:
SUITE 170A
Provider Business Practice Location Address City Name:
ONALASKA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54650-9266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-474-0966
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  IN PROCESS , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com