Provider Demographics
NPI:1265491773
Name:DRAHEIM, RITA (APN)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:DRAHEIM
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 FRONTAGE RD
Mailing Address - Street 2:SUITE 200 B
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-7755
Mailing Address - Country:US
Mailing Address - Phone:907-283-9306
Mailing Address - Fax:907-283-9308
Practice Address - Street 1:805 FRONTAGE RD
Practice Address - Street 2:SUITE 200 B
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7755
Practice Address - Country:US
Practice Address - Phone:907-283-9306
Practice Address - Fax:907-283-9308
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK657363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP03473Medicaid
AKNP03473Medicaid