Provider Demographics
NPI:1164225835
Name:JAQUITH, RACHEL (RN)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:JAQUITH
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 1:16740 STENERSON LN
Mailing Address - Street 2:
Mailing Address - City:HUSON
Mailing Address - State:MT
Mailing Address - Zip Code:59846-8601
Mailing Address - Country:US
Mailing Address - Phone:406-396-6842
Mailing Address - Fax:
Practice Address - Street 1:401 RAILROAD ST W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4178
Practice Address - Country:US
Practice Address - Phone:406-396-6842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT173375163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse