Provider Demographics
NPI:1225132574
Name:DRAKE, VIRGINIA R (RVT, RT, LVN)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:R
Last Name:DRAKE
Suffix:
Gender:F
Credentials:RVT, RT, LVN
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 222
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:TX
Mailing Address - Zip Code:77575-0222
Mailing Address - Country:US
Mailing Address - Phone:936-336-3616
Mailing Address - Fax:
Practice Address - Street 1:2718A N MAIN ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575-3909
Practice Address - Country:US
Practice Address - Phone:936-336-3616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1152782471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography