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General NPI Number Information
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NPI Number | 1326057423
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Entity Type | Individual
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Provider Name | DAVID PETER RAKEY CRNA
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Gender | Male
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1011 WILSHIRE DR
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City | MOUNT VERNON
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State | IL
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Zip | 62864-2743
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Country | US
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Telephone | 618-242-4150
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Fax | 618-244-1696
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Provider Business Mailing Address
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Address Line | 14 FAIRWAY DR
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City | MOUNT VERNON
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State | IL
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Zip | 62864-2621
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Country | US
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Telephone | 618-244-2509
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Fax | 618-244-1696
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 209-0011244
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License Number State | IL
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