Provider Demographics
NPI:1861385858
Name:RACCA, VANNA LEE
Entity type:Individual
Prefix:
First Name:VANNA
Middle Name:LEE
Last Name:RACCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VANNA
Other - Middle Name:LEE
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1008 NE 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-2901
Mailing Address - Country:US
Mailing Address - Phone:541-507-7500
Mailing Address - Fax:541-507-7500
Practice Address - Street 1:550 W SHAWNEE ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-4144
Practice Address - Country:US
Practice Address - Phone:918-910-5186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK223251363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner