Provider Demographics
NPI:1124418363
Name:RAINS, NICHOLAS (PA-C)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:RAINS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E J AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:GRUNDY CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50638-2004
Mailing Address - Country:US
Mailing Address - Phone:815-973-2959
Mailing Address - Fax:
Practice Address - Street 1:101 E J AVE STE 120
Practice Address - Street 2:
Practice Address - City:GRUNDY CENTER
Practice Address - State:IA
Practice Address - Zip Code:50638-2004
Practice Address - Country:US
Practice Address - Phone:319-824-6945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2022-11-29
Deactivation Date:2018-06-03
Deactivation Code:
Reactivation Date:2018-07-10
Provider Licenses
StateLicense IDTaxonomies
OHAT.0042082255A2300X
IA092493363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer