Healthcare Provider Details

I. General information

NPI: 1790694701
Provider Name (Legal Business Name): REBLOOM MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

394 WILLIAMSTOWNE STE 302
DELAFIELD WI
53018-2200
US

IV. Provider business mailing address

802 MOONLIGHT TRL
VERONA WI
53593-8471
US

V. Phone/Fax

Practice location:
  • Phone: 608-354-2356
  • Fax:
Mailing address:
  • Phone: 608-354-2356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RACHEL GRAAP
Title or Position: OWNER
Credential: PMHNP-BC, PMHNP-C
Phone: 608-354-2356