Provider Demographics
NPI:1720408701
Name:RAINES, BRENDA (R N)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:RAINES
Suffix:
Gender:F
Credentials:R N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:SC
Mailing Address - Zip Code:29706-7704
Mailing Address - Country:US
Mailing Address - Phone:803-385-6148
Mailing Address - Fax:
Practice Address - Street 1:129 WYLIE ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:SC
Practice Address - Zip Code:29706-1786
Practice Address - Country:US
Practice Address - Phone:803-385-6152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC72273163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse