Provider Demographics
NPI:1407825334
Name:RAKOVAN, SUSAN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:RAKOVAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 CHRISTLER CT
Mailing Address - Street 2:
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-1359
Mailing Address - Country:US
Mailing Address - Phone:412-299-7776
Mailing Address - Fax:
Practice Address - Street 1:25 HECKEL RD
Practice Address - Street 2:
Practice Address - City:MC KEES ROCKS
Practice Address - State:PA
Practice Address - Zip Code:15136-1651
Practice Address - Country:US
Practice Address - Phone:412-777-6161
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN278569L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered