Healthcare Provider Details

I. General information

NPI: 1679418842
Provider Name (Legal Business Name): RAIN AGAPE ANANAEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 HAMILTON CT
TRAPPE PA
19426-2255
US

IV. Provider business mailing address

615 HAMILTON CT
TRAPPE PA
19426-2255
US

V. Phone/Fax

Practice location:
  • Phone: 707-845-1220
  • Fax:
Mailing address:
  • Phone: 707-845-1220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP034524
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: