Provider Demographics
NPI:1730702747
Name:MALTSBERGER, RAQUEL MINKA (NP-C)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:MINKA
Last Name:MALTSBERGER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MRS
Other - First Name:RAQUEL
Other - Middle Name:MINKA
Other - Last Name:MALTSBERGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:221 TECHNOLOGY PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1369
Mailing Address - Country:US
Mailing Address - Phone:762-235-1000
Mailing Address - Fax:
Practice Address - Street 1:150 GENTILLY BLVD
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-8522
Practice Address - Country:US
Practice Address - Phone:470-490-6670
Practice Address - Fax:770-382-5762
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN265551363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner