Provider Demographics
NPI:1639894967
Name:RACHEL LISLE WELLNESS
Entity type:Organization
Organization Name:RACHEL LISLE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HUNTER
Authorized Official - Middle Name:WALTON
Authorized Official - Last Name:LISLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-922-6167
Mailing Address - Street 1:4020 N MACARTHUR BLVD STE 122 PMB 1110
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038
Mailing Address - Country:US
Mailing Address - Phone:972-922-6167
Mailing Address - Fax:888-858-6905
Practice Address - Street 1:4020 N MACARTHUR BLVD STE 122 PMB 1110
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038
Practice Address - Country:US
Practice Address - Phone:972-922-6167
Practice Address - Fax:888-858-6905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty