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General NPI Number Information
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NPI Number | 1770512956
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Entity Type | Individual
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Provider Name | RUTH A. RACZKOWSKI N.P.
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Gender | Female
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 03/19/2020
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Provider Practice Location Address
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Address Line | 1135 MORTON ST
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City | MATTAPAN
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State | MA
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Zip | 02126-2834
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Country | US
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Telephone | 617-533-2400
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Fax | 617-533-2401
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Provider Business Mailing Address
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Address Line | 67 EUSTIS PKWY
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City | WATERVILLE
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State | ME
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Zip | 04901-5173
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Country | US
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Telephone | 207-873-2136
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Fax | 207-660-4529
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | CNP161020
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License Number State | ME
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