Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | APN.0993898-NP | CO |
N | 363LP2300X | Nurse Practitioner - Primary Care | APN.0993898-NP | CO |
NPI | 1053801647 |
---|---|
Provider Name | Ms. Rachel Jane Mommer |
First Address | Loveland, CO 80538-3551 |
Second Address | Loveland, CO 80538-3551 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2018 |
Last Update Date | 06/04/2020 |