Provider Demographics
NPI:1538831961
Name:RAFFENSBERGER, DENISE (LPN)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:
Last Name:RAFFENSBERGER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:
Other - Last Name:RAFFENSBERGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:7474 S FISKARI DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99623-0336
Mailing Address - Country:US
Mailing Address - Phone:570-426-0946
Mailing Address - Fax:
Practice Address - Street 1:670 W FIREWEED LN
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2562
Practice Address - Country:US
Practice Address - Phone:907-770-0862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK181838164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse