Healthcare Provider Details

I. General information

NPI: 1871339408
Provider Name (Legal Business Name): MRS. RAQUEL ELAINE RHEA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RAQUEL ELAINE KANSAS DOMANN

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 E 17TH PL
AURORA CO
80045-2570
US

IV. Provider business mailing address

4677 WALDEN WAY
DENVER CO
80249-8710
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-5000
  • Fax:
Mailing address:
  • Phone: 405-234-0401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number1694707
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: