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Individual
VIVIAN LEE RAKESTRAW
Active
Individual
VIVIAN LEE RAKESTRAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4778P
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1025939
RN LICENSE
KY
05
—
200981170
—
IN
01
—
4778P
ARNP LICENSE
KY
05
—
7100021840
—
KY
Enumeration date
06/30/2006
Last updated
08/17/2010
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