Healthcare Provider Details

I. General information

NPI: 1760112338
Provider Name (Legal Business Name): RACHEL FLAVIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 11/07/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 DIXON AVE
LAFAYETTE CO
80026-8879
US

IV. Provider business mailing address

1455 DIXON AVE
LAFAYETTE CO
80026-8879
US

V. Phone/Fax

Practice location:
  • Phone: 303-443-8500
  • Fax:
Mailing address:
  • Phone: 303-443-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN2324963
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0999225-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: