Provider Demographics
NPI:1861077117
Name:MORTENSEN, RACHEL ANNE (CNM)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANNE
Last Name:MORTENSEN
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 1:317 N HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2428
Mailing Address - Country:US
Mailing Address - Phone:608-698-2969
Mailing Address - Fax:
Practice Address - Street 1:317 N HICKORY AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2428
Practice Address - Country:US
Practice Address - Phone:931-528-7527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28858367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife