Provider Demographics
NPI:1053801647
Name:MOMMER, RACHEL JANE (DNP, FNP, PMHNP)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:JANE
Last Name:MOMMER
Suffix:
Gender:F
Credentials:DNP, FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 TOPAZ DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-3210
Mailing Address - Country:US
Mailing Address - Phone:970-617-8128
Mailing Address - Fax:970-639-4475
Practice Address - Street 1:1640 TOPAZ DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-3210
Practice Address - Country:US
Practice Address - Phone:970-617-8128
Practice Address - Fax:970-639-4475
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0993898-NP207Q00000X, 2084A0401X, 363LP2300X
COANP.0993898-NP2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care