Provider Demographics
NPI:1053354779
Name:AMICO, RACHELLE M (PA-C)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:M
Last Name:AMICO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:RACHELLE
Other - Middle Name:M
Other - Last Name:KARCUTSKIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-3034
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:1000 E MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-0027
Practice Address - Country:US
Practice Address - Phone:570-820-6020
Practice Address - Fax:570-821-2306
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002735L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA056150Medicare ID - Type Unspecified
S74681Medicare UPIN