Provider Demographics
NPI:1093490617
Name:RACKE, ANITA
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:RACKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4316 ERICA DRIVE
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-0168
Mailing Address - Country:US
Mailing Address - Phone:702-964-3531
Mailing Address - Fax:
Practice Address - Street 1:7465 W LAKE MEAD BLVD STE 116
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1032
Practice Address - Country:US
Practice Address - Phone:702-562-1245
Practice Address - Fax:702-562-8110
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant