Provider Demographics
NPI:1417752320
Name:SNAKE, RAECHELL LYNNANN (LPN)
Entity type:Individual
Prefix:
First Name:RAECHELL
Middle Name:LYNNANN
Last Name:SNAKE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:RAECHELL
Other - Middle Name:LYNNANN
Other - Last Name:MESSENGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:781 GRAND CASINO BLVD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1005
Mailing Address - Country:US
Mailing Address - Phone:405-964-6003
Mailing Address - Fax:
Practice Address - Street 1:781 GRAND CASINO BLVD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1005
Practice Address - Country:US
Practice Address - Phone:405-695-6003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL0065048164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse