Basic Information
Provider Information
NPI: 1265596753
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PRELL
FirstName: RACHEL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: FNP-BC, CWOCN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6601 W THOMAS RD
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850335700
CountryCode: US
TelephoneNumber: 6022437277
FaxNumber: 6232479742
Practice Location
Address1: 6601 W THOMAS RD
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850335700
CountryCode: US
TelephoneNumber: 6022437277
FaxNumber: 6232479742
Other Information
ProviderEnumerationDate: 12/20/2006
LastUpdateDate: 07/16/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WW0000XRN109971AZN Nursing Service ProvidersRegistered NurseWound Care
363LF0000XAP4268AZY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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