Healthcare Provider Details

I. General information

NPI: 1043834963
Provider Name (Legal Business Name): ALEXANDER T RAINES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10604 NE HIGHWAY 99
VANCOUVER WA
98686-5613
US

IV. Provider business mailing address

10604 NE HIGHWAY 99
VANCOUVER WA
98686-5613
US

V. Phone/Fax

Practice location:
  • Phone: 360-567-2211
  • Fax: 360-567-2212
Mailing address:
  • Phone: 360-567-2211
  • Fax: 360-567-2212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: