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General NPI Number Information
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NPI Number | 1558880872
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Entity Type | Individual
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Provider Name | STORMI T RAINES PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/19/2017
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 100 S MAIN ST
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City | WEST SALEM
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State | IL
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Zip | 62476-1202
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Country | US
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Telephone | 618-395-7340
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Fax | 618-395-6020
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Provider Business Mailing Address
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Address Line | 250 N SHADELAND AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4959
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085007436
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License Number State | IL
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