Healthcare Provider Details

I. General information

NPI: 1053801647
Provider Name (Legal Business Name): RACHEL JANE MOMMER DNP, FNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 TOPAZ DR
LOVELAND CO
80537-3210
US

IV. Provider business mailing address

1640 TOPAZ DR
LOVELAND CO
80537-3210
US

V. Phone/Fax

Practice location:
  • Phone: 970-617-8128
  • Fax: 970-639-4475
Mailing address:
  • Phone: 970-617-8128
  • Fax: 970-639-4475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPN.0993898-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPN.0993898-NP
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberAPN.0993898-NP
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberANP.0993898-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: