Provider Demographics
NPI:1619198488
Name:WHITTALL, RACHAEL C (LMP)
Entity type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:C
Last Name:WHITTALL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 O AVE
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-1753
Mailing Address - Country:US
Mailing Address - Phone:360-914-0408
Mailing Address - Fax:
Practice Address - Street 1:601 O AVE
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-1753
Practice Address - Country:US
Practice Address - Phone:360-914-0408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011736174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist