Provider Demographics
NPI:1639682800
Name:ANDERSON, RAKIA (LPN)
Entity type:Individual
Prefix:
First Name:RAKIA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1461 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:MINERAL RIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:44440-9704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1461 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MINERAL RIDGE
Practice Address - State:OH
Practice Address - Zip Code:44440-9704
Practice Address - Country:US
Practice Address - Phone:330-883-4489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.165735.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse