Provider Demographics
NPI:1013220508
Name:RAKOWSKI, JANA (NP)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:RAKOWSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-9491
Mailing Address - Fax:701-323-5709
Practice Address - Street 1:1040 TACOMA AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-7452
Practice Address - Country:US
Practice Address - Phone:701-323-7452
Practice Address - Fax:701-323-6982
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR30783363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND84014Medicaid
ND84014Medicaid