Provider Demographics
NPI:1053175240
Name:RAKESTRAW, JEANETTE NICOLE
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:NICOLE
Last Name:RAKESTRAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 MALVERN AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-2924
Mailing Address - Country:US
Mailing Address - Phone:937-818-3508
Mailing Address - Fax:
Practice Address - Street 1:2125 MALVERN AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-2924
Practice Address - Country:US
Practice Address - Phone:937-818-3508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide