Provider Demographics
NPI:1942027974
Name:RACHAL, BLAIR NICOLE
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:NICOLE
Last Name:RACHAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 HAMBURG LOOP
Mailing Address - Street 2:
Mailing Address - City:SIMMESPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71369-2261
Mailing Address - Country:US
Mailing Address - Phone:318-359-7817
Mailing Address - Fax:
Practice Address - Street 1:229 HAMBURG LOOP
Practice Address - Street 2:
Practice Address - City:SIMMESPORT
Practice Address - State:LA
Practice Address - Zip Code:71369-2261
Practice Address - Country:US
Practice Address - Phone:318-359-7817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA151998163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health