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Individual

RACHEL BONVILLAIN JOSEFCHUK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PMHNP

Contact information

Practice address
1515 E CEDAR AVE STE B-4, FLAGSTAFF, AZ 86004-1645
(928) 779-4550
Mailing address
3307 N MONTE VISTA DR, FLAGSTAFF, AZ 86004-1940
(928) 707-1851

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
229134
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
556723
AZ
01
Z245748
MEDICARE
AZ
Enumeration date
07/17/2019
Last updated
09/22/2020
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