Provider Demographics
NPI:1720605678
Name:BANICK WOOD, RAINEY CELENE (ARNP)
Entity Type:Individual
Prefix:
First Name:RAINEY
Middle Name:CELENE
Last Name:BANICK WOOD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:RAINEY
Other - Middle Name:CELENE
Other - Last Name:BANICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28 SW CHEHALIS AVE
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-1933
Mailing Address - Country:US
Mailing Address - Phone:360-740-1296
Mailing Address - Fax:
Practice Address - Street 1:28 SW CHEHALIS AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-1933
Practice Address - Country:US
Practice Address - Phone:360-790-3697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61083920363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty