Provider Demographics
NPI:1891244935
Name:RAKOVICH, CELESTE M (RN)
Entity Type:Individual
Prefix:MRS
First Name:CELESTE
Middle Name:M
Last Name:RAKOVICH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 RACHEL CARSON TRL
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-8403
Mailing Address - Country:US
Mailing Address - Phone:201-563-3578
Mailing Address - Fax:
Practice Address - Street 1:55 BROWN RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1247
Practice Address - Country:US
Practice Address - Phone:607-274-6361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY670563163W00000X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health