1326366105 NPI number — DR. RACHEL CHRISTINE NIEMET M.D.

Table of content: DR. RACHEL CHRISTINE NIEMET M.D. (NPI 1326366105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326366105 NPI number — DR. RACHEL CHRISTINE NIEMET M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIEMET
Provider First Name:
RACHEL
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ADAMS
Provider Other First Name:
RACHEL
Provider Other Middle Name:
CHRISTINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326366105
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 N GRAND AVE
Provider Second Line Business Mailing Address:
STE 400
Provider Business Mailing Address City Name:
PUEBLO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81003-2700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-423-7170
Provider Business Mailing Address Fax Number:
719-543-1041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 N GRAND AVE
Provider Second Line Business Practice Location Address:
STE 400
Provider Business Practice Location Address City Name:
PUEBLO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81003-2700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-423-7170
Provider Business Practice Location Address Fax Number:
719-543-1041
Provider Enumeration Date:
05/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  DR.0053634 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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