Provider Demographics
NPI:1346825031
Name:BLUMENTHAL, RACHEL SCARLETT (DNP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:SCARLETT
Last Name:BLUMENTHAL
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:SCARLETT
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4108 N SOUTHPORT AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-7425
Mailing Address - Country:US
Mailing Address - Phone:313-613-7516
Mailing Address - Fax:
Practice Address - Street 1:1740 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:866-600-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-14
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.021799363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care