Provider Demographics
NPI:1720399199
Name:RAKIESKI, LORI MAY (RD)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:MAY
Last Name:RAKIESKI
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 MAURUS ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-1120
Mailing Address - Country:US
Mailing Address - Phone:814-834-7091
Mailing Address - Fax:
Practice Address - Street 1:4372 ROUTE 6
Practice Address - Street 2:KANE COMMUNITY HOSPITAL
Practice Address - City:KANE
Practice Address - State:PA
Practice Address - Zip Code:16735-3060
Practice Address - Country:US
Practice Address - Phone:884-837-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN002161133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered