Provider Demographics
NPI:1134439094
Name:RAINEY, DAWN MARY (REGISTERED PROFESSIO)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:MARY
Last Name:RAINEY
Suffix:
Gender:F
Credentials:REGISTERED PROFESSIO
Other - Prefix:MS
Other - First Name:DAWN
Other - Middle Name:MARY
Other - Last Name:HAASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED PROFESSIO
Mailing Address - Street 1:176 MOUNTAIN SPRING ROAD
Mailing Address - Street 2:
Mailing Address - City:MINEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12956
Mailing Address - Country:US
Mailing Address - Phone:518-572-5490
Mailing Address - Fax:518-942-3090
Practice Address - Street 1:176 MOUNTAIN SPRING ROAD
Practice Address - Street 2:
Practice Address - City:MINEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12956
Practice Address - Country:US
Practice Address - Phone:518-572-5490
Practice Address - Fax:518-942-3090
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY502270-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY502270-1OtherTHE UNIVERISTY OF THE STATE OF NEW YORK