Provider Demographics
NPI:1053916379
Name:IVANOV, RACHEL SPENCER (MSN, APRN, PMHNP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:SPENCER
Last Name:IVANOV
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 HALFWAY CV
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-1005
Mailing Address - Country:US
Mailing Address - Phone:512-591-6841
Mailing Address - Fax:
Practice Address - Street 1:705 LANDA ST STE C
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6163
Practice Address - Country:US
Practice Address - Phone:210-360-1590
Practice Address - Fax:210-855-9300
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX902941163WP0808X
TX1030787363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health