Provider Demographics
NPI:1417208885
Name:HARTWELL, RACHEL M (CRNA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:M
Last Name:HARTWELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:M
Other - Last Name:BOLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:7469 SPLENDID VIEW DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-7103
Mailing Address - Country:US
Mailing Address - Phone:423-402-7861
Mailing Address - Fax:
Practice Address - Street 1:1200 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2529
Practice Address - Country:US
Practice Address - Phone:706-259-4435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN175026367500000X
GARN192238367500000X
TNAPN16935367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1530477Medicaid
P01186874OtherRAILROAD MEDICARE
TN4345876OtherBCBS OF TN
TN1530477Medicaid