Provider Demographics
NPI:1245270891
Name:RAINWATER, HEATHER A (MD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:A
Last Name:RAINWATER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:A
Other - Last Name:LICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4410 REGENT STREET
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-4901
Mailing Address - Country:US
Mailing Address - Phone:608-233-9746
Mailing Address - Fax:608-233-0026
Practice Address - Street 1:4410 REGENT STREET
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-4901
Practice Address - Country:US
Practice Address - Phone:608-233-9746
Practice Address - Fax:608-233-0026
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-29458208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100420280AMedicaid