Provider Demographics
NPI:1609525781
Name:PITTNER, RACHEL JEAN (CRNA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:JEAN
Last Name:PITTNER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3041 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68112-3040
Mailing Address - Country:US
Mailing Address - Phone:605-877-4144
Mailing Address - Fax:
Practice Address - Street 1:201 RIDGE ST STE 102
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4643
Practice Address - Country:US
Practice Address - Phone:712-396-4359
Practice Address - Fax:712-396-7888
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD168109367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered