Provider Demographics
NPI:1073114989
Name:RAINES, AMIE MARIE (RN)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:MARIE
Last Name:RAINES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:AMIE
Other - Middle Name:MARIE
Other - Last Name:KNOUFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1012 LOFTON DR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45315-8741
Mailing Address - Country:US
Mailing Address - Phone:937-381-7293
Mailing Address - Fax:
Practice Address - Street 1:70 BIRCH ALY STE 240
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440-1477
Practice Address - Country:US
Practice Address - Phone:937-672-0892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH324628163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse