Provider Demographics
NPI:1861202103
Name:RAKOTZ, AMBER LYNN (LPN)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:RAKOTZ
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 1:1850 ROYAL AVE
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-1190
Mailing Address - Country:US
Mailing Address - Phone:712-339-7007
Mailing Address - Fax:
Practice Address - Street 1:1850 ROYAL AVE
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360-1190
Practice Address - Country:US
Practice Address - Phone:712-336-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP62136164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse