Healthcare Provider Details

I. General information

NPI: 1649630930
Provider Name (Legal Business Name): BROOK RACHEL WEBER BNS, RN, QMHP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SHELTON MCMURPHEY BLVD SUITE 101
EUGENE OR
97401-5015
US

IV. Provider business mailing address

150 SHELTON MCMURPHEY BLVD SUITE 101
EUGENE OR
97401-5015
US

V. Phone/Fax

Practice location:
  • Phone: 541-210-8090
  • Fax: 541-210-5310
Mailing address:
  • Phone: 541-210-8090
  • Fax: 541-210-5310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19-QMHPC-00723
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201041290RN
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202111133NP-PP
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier500759136
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: