Provider Demographics
NPI:1144275454
Name:FLEMING, RACHEL IRENE
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:IRENE
Last Name:FLEMING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:958 PARKLAND DR
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-5084
Mailing Address - Country:US
Mailing Address - Phone:715-894-7012
Mailing Address - Fax:
Practice Address - Street 1:27040 COUNTY ROAD 9
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-5456
Practice Address - Country:US
Practice Address - Phone:218-751-6405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1405232163W00000X
MNR149523-2367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN002431700Medicaid
MN430004957Medicare PIN