Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD17410 | OR |
N | 111NI0900X | Internist | MD17410 | OR |
Y | 207RH0002X | Hospice and Palliative Medicine | MD17410 | OR |
NPI | 1285862565 |
---|---|
Provider Name | Rachel Rackow |
First Address | Portland, OR 97208-3158 |
Second Address | Portland, OR 97213 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2009 |
Last Update Date | 20/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500709796 | (05) | OR |