MEDICARE: MRS. ROBYN ANNE RAFTER MSN, APRN, FPNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	112688	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	112688	OTHER	NE	NA

General Provider Information

NPI Number	:	1992365001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROBYN ANNE RAFTER MSN, APRN, FPNP-BC

Provider Business Mailing Address
First Line	:	5160 N 175TH CIR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-3196
Country	:	US
Telephone Number	:	402-517-7996
Fax Number	:

Provider Business Practice Location Address
First Line	:	5160 N 175TH CIR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-3196
Country	:	US
Telephone Number	:	402-517-7996
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2019
Last Update Date	:	06/20/2019

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