Provider Demographics
NPI:1245736529
Name:RAINER, PAMELA ANN (LPN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:RAINER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 N PLAZA BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-1757
Mailing Address - Country:US
Mailing Address - Phone:740-851-5381
Mailing Address - Fax:740-851-5381
Practice Address - Street 1:42 N PLAZA BLVD STE C
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-1757
Practice Address - Country:US
Practice Address - Phone:740-851-5381
Practice Address - Fax:740-851-5381
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN090038-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse