Provider Demographics
NPI:1184051401
Name:RAINES, LAUREL B (PA-C)
Entity type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:B
Last Name:RAINES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAUREL
Other - Middle Name:B
Other - Last Name:CAPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1307 FEDERAL ST STE 301
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4769
Mailing Address - Country:US
Mailing Address - Phone:412-359-3751
Mailing Address - Fax:412-442-2335
Practice Address - Street 1:1307 FEDERAL ST STE 301
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212
Practice Address - Country:US
Practice Address - Phone:412-359-3751
Practice Address - Fax:412-442-2335
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA004934363A00000X
PAMA056352363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant