Healthcare Provider Details

I. General information

NPI: 1063977957
Provider Name (Legal Business Name): RACHEL NICOLE WARREN APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL NICOLE DEPRATTER RN

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8170 33RD AVE S
BLOOMINGTON MN
55425-4516
US

IV. Provider business mailing address

8170 33RD AVE S
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-883-7029
  • Fax: 952-993-1456
Mailing address:
  • Phone: 952-883-7029
  • Fax: 952-993-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9808-33
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6417
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: