Provider Demographics
NPI:1932960036
Name:MICCICHE, RAJWANTIE (ELECTROLOGIST)
Entity Type:Individual
Prefix:
First Name:RAJWANTIE
Middle Name:
Last Name:MICCICHE
Suffix:
Gender:F
Credentials:ELECTROLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 DELANEY HILLS LN
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-3982
Mailing Address - Country:US
Mailing Address - Phone:919-307-9296
Mailing Address - Fax:
Practice Address - Street 1:2420 DELANEY HILLS LN
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-3982
Practice Address - Country:US
Practice Address - Phone:518-867-2532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCE-339374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician