Provider Demographics
NPI:1255982930
Name:RAINBOW, DOVE (PA-C)
Entity type:Individual
Prefix:
First Name:DOVE
Middle Name:
Last Name:RAINBOW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:883 CHARLES RIVER ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-1007
Mailing Address - Country:US
Mailing Address - Phone:208-610-5557
Mailing Address - Fax:
Practice Address - Street 1:801 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-3926
Practice Address - Country:US
Practice Address - Phone:508-842-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant