Provider Demographics
NPI:1811546880
Name:RASKIN, ELLEN DAWN
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:DAWN
Last Name:RASKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3237 PEACEFUL SHADOWS CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4056
Mailing Address - Country:US
Mailing Address - Phone:702-456-3377
Mailing Address - Fax:702-456-3377
Practice Address - Street 1:3237 PEACEFUL SHADOWS CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4056
Practice Address - Country:US
Practice Address - Phone:702-456-3377
Practice Address - Fax:702-456-3377
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
NV251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health