Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | NP02547 | OH |
NPI | 1043209281 |
---|---|
Provider Name | Connie Sue Rackow |
First Address | Wooster, OH 44691 |
Second Address | Wooster, OH 44691 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2005 |
Last Update Date | 25/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2450637 | (05) | OH |
P7438 | (02) |