Provider Demographics
NPI:1689672453
Name:RAKER, LANE S (NP)
Entity Type:Individual
Prefix:MRS
First Name:LANE
Middle Name:S
Last Name:RAKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 GRAYDON AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1208
Mailing Address - Country:US
Mailing Address - Phone:757-624-9518
Mailing Address - Fax:
Practice Address - Street 1:824 GREENBRIER PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3697
Practice Address - Country:US
Practice Address - Phone:757-410-7390
Practice Address - Fax:757-410-7395
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024062335363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00W068W03Medicare ID - Type Unspecified
VAQ24595Medicare UPIN