Provider Demographics
NPI:1508280769
Name:STALKER, RACHAEL LYNN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:LYNN
Last Name:STALKER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 BULWARK RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:GLEN HAVEN
Mailing Address - State:CO
Mailing Address - Zip Code:80532
Mailing Address - Country:US
Mailing Address - Phone:970-577-1417
Mailing Address - Fax:
Practice Address - Street 1:655 BULWARK RIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:GLEN HAVEN
Practice Address - State:CO
Practice Address - Zip Code:80532
Practice Address - Country:US
Practice Address - Phone:970-577-1417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-08
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991024-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO35831383Medicaid