Provider Demographics
NPI:1336315597
Name:DRAKE, DENISE RENEE (RNFA)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:RENEE
Last Name:DRAKE
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 RALPH MC GILL BLVD NE UNIT 1207
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1134
Mailing Address - Country:US
Mailing Address - Phone:843-271-7465
Mailing Address - Fax:955-485-0217
Practice Address - Street 1:747 RALPH MCGILL BLVD NE UNIT 1207
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1134
Practice Address - Country:US
Practice Address - Phone:843-271-7465
Practice Address - Fax:955-485-0217
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN108059163WS0121X
SCR200164163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery