Provider Demographics
NPI:1992012330
Name:RAINES, JANA (LMP)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:RAINES
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 FOOTE ST SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5432
Mailing Address - Country:US
Mailing Address - Phone:360-689-4888
Mailing Address - Fax:
Practice Address - Street 1:302 COLUMBIA ST NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1031
Practice Address - Country:US
Practice Address - Phone:360-689-4888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60130444172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker