Provider Demographics
NPI:1821879099
Name:RAINEY, TAMMY SUE (RN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:SUE
Last Name:RAINEY
Suffix:
Gender:F
Credentials:RN
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 156
Mailing Address - Street 2:
Mailing Address - City:VAN METER
Mailing Address - State:IA
Mailing Address - Zip Code:50261-0156
Mailing Address - Country:US
Mailing Address - Phone:515-205-0797
Mailing Address - Fax:
Practice Address - Street 1:211 MAIN ST
Practice Address - Street 2:
Practice Address - City:VAN METER
Practice Address - State:IA
Practice Address - Zip Code:50261-9708
Practice Address - Country:US
Practice Address - Phone:515-205-0797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA125084163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse