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General NPI Number Information
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NPI Number | 1609645191
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Entity Type | Individual
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Provider Name | VICTORIA GLADDEN RAIN PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/26/2023
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 73-5618 MAIAU ST STE A204
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City | KAILUA KONA
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State | HI
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Zip | 96740-2634
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Country | US
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Telephone | 808-329-1146
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Fax | 808-329-1120
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Provider Business Mailing Address
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Address Line | PO BOX 13834
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City | TALLAHASSEE
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State | FL
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Zip | 32317-3834
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Country | US
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Telephone | 850-205-6232
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Fax | 855-975-0615
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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 | 9118307
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License Number State | FL
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