Healthcare Provider Details

I. General information

NPI: 1548949738
Provider Name (Legal Business Name): ALICIA RASCHKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 NIGHTINGALE ROAD
EDWARDS AFB CA
93524-5529
US

IV. Provider business mailing address

30 NIGHTINGALE ROAD
EDWARDS AFB CA
93524-0001
US

V. Phone/Fax

Practice location:
  • Phone: 661-277-2052
  • Fax: 661-275-2844
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: