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General NPI Number Information
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NPI Number | 1649709866
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Entity Type | Individual
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Provider Name | RAINIE NICESWANGER
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Gender | Female
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Dates
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Enumeration Date | 06/10/2017
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 1452 CLARK ST
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City | CAMBRIDGE
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State | OH
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Zip | 43725-9617
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Country | US
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Telephone | 740-621-9924
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Fax | 833-450-6108
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Provider Business Mailing Address
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Address Line | 4506 JOHNSON RIDGE RD
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City | STOCKPORT
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State | OH
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Zip | 43787-9592
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Country | US
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Telephone | 740-434-3810
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN96718NP
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.020737
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License Number State | OH
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