Provider Demographics
NPI:1780940064
Name:RIEDEL, RACHEL ELIZABETH (ANP-BC)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ELIZABETH
Last Name:RIEDEL
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 SE MAIN ST STE 60
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2474
Mailing Address - Country:US
Mailing Address - Phone:503-257-0959
Mailing Address - Fax:503-256-7757
Practice Address - Street 1:10000 SE MAIN ST STE 60
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2474
Practice Address - Country:US
Practice Address - Phone:503-257-0959
Practice Address - Fax:503-256-7757
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005024512163W00000X
MO2012009251363LA2200X
OR201910562NP-PP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse