Provider Demographics
NPI:1770388670
Name:RAE, TINA
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:RAE
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 1:105 W DECATUR ST
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:NE
Mailing Address - Zip Code:69026-5245
Mailing Address - Country:US
Mailing Address - Phone:308-350-1008
Mailing Address - Fax:
Practice Address - Street 1:201 W 2ND ST
Practice Address - Street 2:
Practice Address - City:MC COOK
Practice Address - State:NE
Practice Address - Zip Code:69001-3607
Practice Address - Country:US
Practice Address - Phone:308-350-1008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant