Provider Demographics
NPI:1881669372
Name:RAWSON, NICOLE RUTH (CNM)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:RUTH
Last Name:RAWSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6725
Mailing Address - Country:US
Mailing Address - Phone:330-729-4350
Mailing Address - Fax:330-729-4351
Practice Address - Street 1:8401 MARKET ST
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6725
Practice Address - Country:US
Practice Address - Phone:330-729-4350
Practice Address - Fax:330-729-4351
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCNM107718367A00000X
OHAPRN.CNP.0019511367A00000X
PAMW008527L367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001810103Medicaid
OH2186263Medicaid
PA001810103Medicaid