Provider Demographics
NPI:1164146049
Name:RAINES-WARE, MACKENZIE A (CBS)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:A
Last Name:RAINES-WARE
Suffix:
Gender:F
Credentials:CBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 MINE RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-0221
Mailing Address - Country:US
Mailing Address - Phone:540-623-0272
Mailing Address - Fax:
Practice Address - Street 1:3308 MINE RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-0221
Practice Address - Country:US
Practice Address - Phone:540-623-0272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN