Provider Demographics
NPI:1366930992
Name:BEAUDOIN, RACHELE (RN)
Entity type:Individual
Prefix:
First Name:RACHELE
Middle Name:
Last Name:BEAUDOIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3823 PREACHER RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:NY
Mailing Address - Zip Code:14855-9758
Mailing Address - Country:US
Mailing Address - Phone:513-907-3343
Mailing Address - Fax:
Practice Address - Street 1:3823 PREACHER RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:NY
Practice Address - Zip Code:14855-9758
Practice Address - Country:US
Practice Address - Phone:513-907-3343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY710913-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse