Provider Demographics
NPI:1861641516
Name:CABRAL GUEVARA, RACHAEL A (FNP)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:A
Last Name:CABRAL GUEVARA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:HAWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7210
Mailing Address - Fax:
Practice Address - Street 1:301 BAY PARK SQ
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5104
Practice Address - Country:US
Practice Address - Phone:920-592-9475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3581-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI075100125Medicare Oscar/Certification
WIK400163086Medicare Oscar/Certification
WIK400144063Medicare Oscar/Certification
WI100200073Medicare Oscar/Certification
WI071700067Medicare Oscar/Certification
WI078450054Medicare Oscar/Certification
WI590050056Medicare Oscar/Certification