Healthcare Provider Details

I. General information

NPI: 1710820063
Provider Name (Legal Business Name): RACHEL MAE REDFEARN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37424 COUNTY ROAD 45
EATON CO
80615-9109
US

IV. Provider business mailing address

37424 COUNTY ROAD 45
EATON CO
80615-9109
US

V. Phone/Fax

Practice location:
  • Phone: 719-358-1728
  • Fax:
Mailing address:
  • Phone: 719-358-1728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number1631515
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: