Provider Demographics
NPI:1003003773
Name:RAINE, ANDREA (CPM, LM)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:RAINE
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-4503
Mailing Address - Country:US
Mailing Address - Phone:715-345-1222
Mailing Address - Fax:
Practice Address - Street 1:2108 CHURCH ST
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-4503
Practice Address - Country:US
Practice Address - Phone:715-345-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30-049175M00000X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No175M00000XOther Service ProvidersMidwife, Lay