Provider Demographics
NPI:1699011742
Name:OKEN, RACHEL ALYSON (CRNA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ALYSON
Last Name:OKEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:68 SOUTH SERVICE ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2358
Mailing Address - Country:US
Mailing Address - Phone:516-945-3000
Mailing Address - Fax:516-945-3131
Practice Address - Street 1:4320 SEMINARY ROAD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-3556
Practice Address - Country:US
Practice Address - Phone:703-504-3789
Practice Address - Fax:703-295-9369
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170676367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1699011742Medicaid
VA1699011742Medicaid