Healthcare Provider Details

I. General information

NPI: 1275298713
Provider Name (Legal Business Name): MRS. RACHEL ATWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2021
Last Update Date: 10/31/2021
Certification Date: 10/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 NEWPORT ST
DENVER CO
80220-5506
US

IV. Provider business mailing address

620 NEWPORT ST
DENVER CO
80220-5506
US

V. Phone/Fax

Practice location:
  • Phone: 309-798-8078
  • Fax:
Mailing address:
  • Phone: 309-798-8078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number1656036
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: