Healthcare Provider Details

I. General information

NPI: 1710817549
Provider Name (Legal Business Name): RACHEL DONNELLAN RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W 9TH AVE UNIT 4506
DENVER CO
80204-4060
US

IV. Provider business mailing address

150 W 9TH AVE UNIT 4506
DENVER CO
80204-4060
US

V. Phone/Fax

Practice location:
  • Phone: 781-439-0793
  • Fax:
Mailing address:
  • Phone: 781-439-0793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164.023736
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: