Provider Demographics
NPI:1114307519
Name:RAKE, VIRGINIA MARIE
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:MARIE
Last Name:RAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:MARIE
Other - Last Name:BREITLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSS
Mailing Address - Street 1:PO BOX 481
Mailing Address - Street 2:
Mailing Address - City:CARLTON
Mailing Address - State:OR
Mailing Address - Zip Code:97111-0481
Mailing Address - Country:US
Mailing Address - Phone:503-334-6263
Mailing Address - Fax:503-585-0491
Practice Address - Street 1:819 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4433
Practice Address - Country:US
Practice Address - Phone:503-722-8205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist