Provider Demographics
NPI:1508270760
Name:RAAB, RITA (LPN)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:RAAB
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:FAYE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3897 WINDMILL DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-6068
Mailing Address - Country:US
Mailing Address - Phone:989-708-6095
Mailing Address - Fax:
Practice Address - Street 1:3897 WINDMILL DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-6068
Practice Address - Country:US
Practice Address - Phone:989-708-6095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703110684164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse