Provider Demographics
NPI:1457476111
Name:RAKIECKI, AMBER D (BA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:D
Last Name:RAKIECKI
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 NW F ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-2052
Mailing Address - Country:US
Mailing Address - Phone:541-479-2966
Mailing Address - Fax:541-479-1652
Practice Address - Street 1:322 NW F ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2052
Practice Address - Country:US
Practice Address - Phone:541-479-2966
Practice Address - Fax:541-479-1652
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist