Provider Demographics
NPI:1649709866
Name:NICESWANGER, RAINIE
Entity type:Individual
Prefix:
First Name:RAINIE
Middle Name:
Last Name:NICESWANGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4506 JOHNSON RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STOCKPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43787-9592
Mailing Address - Country:US
Mailing Address - Phone:740-434-3810
Mailing Address - Fax:
Practice Address - Street 1:1452 CLARK ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-9617
Practice Address - Country:US
Practice Address - Phone:740-621-9924
Practice Address - Fax:833-450-6108
Is Sole Proprietor?:No
Enumeration Date:2017-06-10
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN96718NP363LF0000X
OHAPRN.CNP.020737363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily