Provider Demographics
NPI:1730459470
Name:RAFFENSPERGER, RICHARD EUGENE (LPN)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:EUGENE
Last Name:RAFFENSPERGER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SCHOOL HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-3120
Mailing Address - Country:US
Mailing Address - Phone:717-627-3392
Mailing Address - Fax:
Practice Address - Street 1:12 SCHOOL HOUSE LN
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-3120
Practice Address - Country:US
Practice Address - Phone:717-627-3392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN253296L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse