Basic Information
Provider Information
NPI: 1639445281
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MEADOWS
FirstName: RACHEL
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: NP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1906 BELLEVIEW AVE SE
Address2:  
City: ROANOKE
State: VA
PostalCode: 240141838
CountryCode: US
TelephoneNumber: 5409817000
FaxNumber: 5409854780
Practice Location
Address1: 1906 BELLEVIEW AVE SE
Address2:  
City: ROANOKE
State: VA
PostalCode: 240141838
CountryCode: US
TelephoneNumber: 5409817000
FaxNumber: 5409854780
Other Information
ProviderEnumerationDate: 03/28/2012
LastUpdateDate: 03/28/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X0024169916VAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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