MEDICARE: RACHEL DIANE HART PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	G178381	IA

General Provider Information

NPI Number	:	1003672981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL DIANE HART PMHNP-BC

Provider Business Mailing Address
First Line	:	2010 E 38TH ST STE 205
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52807-1179
Country	:	US
Telephone Number	:	319-800-5564
Fax Number	:

Provider Business Practice Location Address
First Line	:	2010 E 38TH ST STE 205
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52807-1179
Country	:	US
Telephone Number	:	319-800-5564
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2024
Last Update Date	:	03/24/2024

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