Basic Information
Provider Information
NPI: 1366782468
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GURTOWSKY
FirstName: RACHEL
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
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OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
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Mailing Information
Address1: 3621 SOUTH STATE STREET
Address2: 700 KMS PLACE
City: ANN ARBOR
State: MI
PostalCode: 48108
CountryCode: US
TelephoneNumber: 7349362047
FaxNumber:  
Practice Location
Address1: 1500 EAST MEDICAL CENTER DRIVE
Address2: 6TH FLOOR C.S. MOTT CHILDRENS HOSPITAL
City: ANN ARBOR
State: MI
PostalCode: 481094234
CountryCode: US
TelephoneNumber: 7349364185
FaxNumber: 7349367635
Other Information
ProviderEnumerationDate: 02/26/2013
LastUpdateDate: 02/26/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X4704248854MIY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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