Provider Demographics
NPI:1255871281
Name:CORNETT-OLSSON, RACHEL (CNM)
Entity type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:
Last Name:CORNETT-OLSSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 AVANT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78210-4106
Mailing Address - Country:US
Mailing Address - Phone:515-669-9064
Mailing Address - Fax:
Practice Address - Street 1:214 AVANT AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78210-4106
Practice Address - Country:US
Practice Address - Phone:515-669-9064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133293367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife