Provider Demographics
NPI:1609380708
Name:RAKSTANG, EUFEMIA PANOLINO (LPN)
Entity Type:Individual
Prefix:
First Name:EUFEMIA
Middle Name:PANOLINO
Last Name:RAKSTANG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 E JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-1621
Mailing Address - Country:US
Mailing Address - Phone:224-520-0522
Mailing Address - Fax:
Practice Address - Street 1:5109 WORLD DAIRY DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-3807
Practice Address - Country:US
Practice Address - Phone:608-242-0220
Practice Address - Fax:608-242-1166
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI317664164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse