Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | SP021500 | PA |
NPI | 1003479700 |
---|---|
Provider Name | Rhonda Myra Rakow |
First Address | West Chester, PA 19382-8703 |
Second Address | West Chester, PA 19382-8703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2019 |
Last Update Date | 09/06/2021 |