Provider Demographics
NPI:1205124401
Name:RACKER, NICHOLAS S (DO)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:S
Last Name:RACKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E LIBERTY ST STE 555
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89501-2110
Mailing Address - Country:US
Mailing Address - Phone:775-348-1900
Mailing Address - Fax:775-348-1912
Practice Address - Street 1:1 E LIBERTY ST STE 555
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-2110
Practice Address - Country:US
Practice Address - Phone:775-348-1900
Practice Address - Fax:775-348-1912
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO1946207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology