Provider Demographics
NPI:1053113662
Name:MAYEN, RACHEAL
Entity type:Individual
Prefix:
First Name:RACHEAL
Middle Name:
Last Name:MAYEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2481 GLACIER DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-3256
Mailing Address - Country:US
Mailing Address - Phone:402-515-9659
Mailing Address - Fax:
Practice Address - Street 1:2481 GLACIER DR
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-3256
Practice Address - Country:US
Practice Address - Phone:402-515-9659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty