Provider Demographics
NPI:1396059325
Name:RAKERS, COLEEN KAREN (ANP-BC)
Entity type:Individual
Prefix:MS
First Name:COLEEN
Middle Name:KAREN
Last Name:RAKERS
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 S LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:PANA
Mailing Address - State:IL
Mailing Address - Zip Code:62557-1689
Mailing Address - Country:US
Mailing Address - Phone:217-562-2143
Mailing Address - Fax:217-562-2251
Practice Address - Street 1:217 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:PANA
Practice Address - State:IL
Practice Address - Zip Code:62557-1689
Practice Address - Country:US
Practice Address - Phone:217-562-2143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010022942363LA2200X
IL209016904363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health