Provider Demographics
NPI:1407560451
Name:RAINEY, PAMELA MARIE (REGISTER NURSE)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:MARIE
Last Name:RAINEY
Suffix:
Gender:F
Credentials:REGISTER NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-1503
Mailing Address - Country:US
Mailing Address - Phone:912-492-1919
Mailing Address - Fax:
Practice Address - Street 1:5015 22ND AVE
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-1503
Practice Address - Country:US
Practice Address - Phone:912-492-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-122834163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1811347727OtherCASE MANAGER
AL272348040Medicaid