Provider Demographics
NPI:1164020483
Name:RAINESALO, DARIL RENEE
Entity Type:Individual
Prefix:
First Name:DARIL
Middle Name:RENEE
Last Name:RAINESALO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 WOODGLEN DR
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-9035
Mailing Address - Country:US
Mailing Address - Phone:701-230-0075
Mailing Address - Fax:
Practice Address - Street 1:513 WOODGLEN DR
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-9035
Practice Address - Country:US
Practice Address - Phone:701-230-0075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant