Provider Demographics
NPI:1396119046
Name:SALTER, RACHELE K (FNP-BC)
Entity type:Individual
Prefix:
First Name:RACHELE
Middle Name:K
Last Name:SALTER
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 1:2494 E HARBOR CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-9600
Mailing Address - Country:US
Mailing Address - Phone:970-812-3776
Mailing Address - Fax:970-279-8667
Practice Address - Street 1:2494 E HARBOR CIR
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-9600
Practice Address - Country:US
Practice Address - Phone:970-812-3776
Practice Address - Fax:303-933-5265
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO180181163W00000X
COAPN.0991972-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO27230261Medicaid