Provider Demographics
NPI:1417298829
Name:RAIN, ELISHA LUCIA (MS, CN)
Entity Type:Individual
Prefix:
First Name:ELISHA
Middle Name:LUCIA
Last Name:RAIN
Suffix:
Gender:F
Credentials:MS, CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:WA
Mailing Address - Zip Code:98342-0094
Mailing Address - Country:US
Mailing Address - Phone:206-849-9398
Mailing Address - Fax:
Practice Address - Street 1:9431 COPPERTOP LOOP NE
Practice Address - Street 2:SUITE B
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-3684
Practice Address - Country:US
Practice Address - Phone:206-849-9398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-09
Last Update Date:2013-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU 60304324133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist