Healthcare Provider Details

I. General information

NPI: 1295325785
Provider Name (Legal Business Name): BAYINK-RAINE FREDERICK FALTER DNP, NPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 08/31/2024
Certification Date: 08/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 GEARY PL UNIT 2918
LAS VEGAS NV
89109-0272
US

IV. Provider business mailing address

2831 GEARY PL UNIT 2918
LAS VEGAS NV
89109-0272
US

V. Phone/Fax

Practice location:
  • Phone: 775-513-3852
  • Fax:
Mailing address:
  • Phone: 775-513-3852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number836624
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number836624
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number836624
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number836624
License Number StateNV
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number836624
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: