Provider Demographics
NPI:1558631143
Name:CRAIN, RITA THOMANN (PNP)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:THOMANN
Last Name:CRAIN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SHELTON ST
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1762
Mailing Address - Country:US
Mailing Address - Phone:919-968-3652
Mailing Address - Fax:919-969-2476
Practice Address - Street 1:400 SHELTON ST
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1762
Practice Address - Country:US
Practice Address - Phone:919-968-3652
Practice Address - Fax:919-969-2476
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC136824363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5002181OtherNURSE PRACTITIONER APPROVAL NUMBER