Provider Demographics
NPI:1205092293
Name:ALKINS, RAWLE O (LPN)
Entity type:Individual
Prefix:MR
First Name:RAWLE
Middle Name:O
Last Name:ALKINS
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 1:628 BEACH 69TH STREET
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692
Mailing Address - Country:US
Mailing Address - Phone:718-755-9700
Mailing Address - Fax:
Practice Address - Street 1:628 BEACH 69TH ST
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1336
Practice Address - Country:US
Practice Address - Phone:718-755-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267937164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02300636Medicaid