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General NPI Number Information
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NPI Number | 1386162980
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Entity Type | Individual
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Provider Name | RITA Y RAINES FNP
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Gender | Female
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Dates
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Enumeration Date | 09/02/2017
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Last Update Date | 09/02/2017
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Provider Practice Location Address
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Address Line | 551 GRANBY LN
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City | COLUMBIA
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State | SC
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Zip | 29201-4655
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Country | US
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Telephone | 864-530-2008
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Fax |
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Provider Business Mailing Address
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Address Line | 95 LAUREL LN
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City | CAMPOBELLO
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State | SC
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Zip | 29322-9212
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Country | US
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Telephone | 284-589-7748
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | F06172631
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License Number State | SC
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