Provider Demographics
NPI:1114103850
Name:RAIC, REBECCA DIANNE (MSN, RN, CPNP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:DIANNE
Last Name:RAIC
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Gender:F
Credentials:MSN, RN, CPNP
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Mailing Address - Street 1:3278 COUNTRY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-7029
Mailing Address - Country:US
Mailing Address - Phone:314-487-0222
Mailing Address - Fax:314-487-0222
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:7E19
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-4514
Practice Address - Fax:314-454-4761
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
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Provider Licenses
StateLicense IDTaxonomies
MO110918363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics