Basic Information
Provider Information
NPI: 1003299637
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ONDEK
FirstName: RACHEL
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 120 WILLIAM PENN PLZ
Address2:  
City: DURHAM
State: NC
PostalCode: 277042150
CountryCode: US
TelephoneNumber: 9192205255
FaxNumber: 1992121276
Practice Location
Address1: 100 KELLIE DR
Address2:  
City: SMITHFIELD
State: NC
PostalCode: 275779444
CountryCode: US
TelephoneNumber: 9199341094
FaxNumber: 9199349044
Other Information
ProviderEnumerationDate: 07/01/2015
LastUpdateDate: 02/08/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/08/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X0010-10964NCY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363A00000X085-005520ILN Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363A00000X085005520ILN Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

ID Information
IDTypeStateIssuerDescription
0010-1096401NCSTATE MEDICAL LICENSEOTHER


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