Provider Demographics
NPI:1104229483
Name:ADAIR, RACHAEL (CNM, PMHNP)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:ADAIR
Suffix:
Gender:F
Credentials:CNM, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1682 CLARA AVE
Mailing Address - Street 2:
Mailing Address - City:FORTUNA
Mailing Address - State:CA
Mailing Address - Zip Code:95540-3814
Mailing Address - Country:US
Mailing Address - Phone:707-599-8839
Mailing Address - Fax:
Practice Address - Street 1:3309 RENNER DR
Practice Address - Street 2:
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-3119
Practice Address - Country:US
Practice Address - Phone:707-725-6108
Practice Address - Fax:707-725-9674
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA751747163W00000X
CA95011778363LP0808X
WAAPA60839107363LX0001X
CA235732176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology