Healthcare Provider Details

I. General information

NPI: 1093285629
Provider Name (Legal Business Name): NIMRAT BAINS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 FARSON ST STE 100
BELPRE OH
45714-0016
US

IV. Provider business mailing address

116 WYNDHAM KNOB
PARKERSBURG WV
26104-9431
US

V. Phone/Fax

Practice location:
  • Phone: 740-423-3640
  • Fax:
Mailing address:
  • Phone: 315-420-9983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.005784RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: