Provider Demographics
NPI:1114562121
Name:MENDONCA-HASENBEIN, RACHEL M (MSN, CRNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:M
Last Name:MENDONCA-HASENBEIN
Suffix:
Gender:F
Credentials:MSN, CRNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 LAKESHORE DR STE 150
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-8832
Mailing Address - Country:US
Mailing Address - Phone:205-871-6926
Mailing Address - Fax:
Practice Address - Street 1:3000 RIVERCHASE GALLERIA STE 500
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-2365
Practice Address - Country:US
Practice Address - Phone:205-994-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-143865163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse