Healthcare Provider Details

I. General information

NPI: 1649443581
Provider Name (Legal Business Name): RACHEL A WOMMACK R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 NIZHONI BLVD
GALLUP NM
87301-5748
US

IV. Provider business mailing address

4233 MONTGOMERY BLVD NE STE 200
ALBUQUERQUE NM
87109-6707
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-1000
  • Fax: 505-722-1765
Mailing address:
  • Phone: 505-906-1170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberR62243
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: