Provider Demographics
NPI:1932817210
Name:RAKKE, TONI RENEE (RN)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:RENEE
Last Name:RAKKE
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 1:3124 321ST ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-9529
Mailing Address - Country:US
Mailing Address - Phone:320-200-8752
Mailing Address - Fax:
Practice Address - Street 1:14 7TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4753
Practice Address - Country:US
Practice Address - Phone:320-200-8752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
MN189628-4163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness Coach