Provider Demographics
NPI:1720403827
Name:RAINES, MICHAELA (CRNP)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:RAINES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 N CEDAR CREST BLVD STE 411
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2323
Mailing Address - Country:US
Mailing Address - Phone:610-969-1914
Mailing Address - Fax:610-969-3951
Practice Address - Street 1:2545 SCHOENERSVILLE RD
Practice Address - Street 2:5TH FLOOR LVH-M SOUTH
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7300
Practice Address - Country:US
Practice Address - Phone:484-884-6503
Practice Address - Fax:484-884-6504
Is Sole Proprietor?:No
Enumeration Date:2014-02-26
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013712363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health