Provider Demographics
NPI:1518445196
Name:SOUTHERN, RACHAEL L (NURSE)
Entity type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:L
Last Name:SOUTHERN
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9822 CORAL DR SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-3306
Mailing Address - Country:US
Mailing Address - Phone:253-232-0778
Mailing Address - Fax:
Practice Address - Street 1:9822 CORAL DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-3306
Practice Address - Country:US
Practice Address - Phone:253-232-0778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60337656163W00000X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse