Provider Demographics
NPI:1124314448
Name:RAINEY, JILLALISON LEE (RN, BSN)
Entity type:Individual
Prefix:
First Name:JILLALISON
Middle Name:LEE
Last Name:RAINEY
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 POMELO DRIVE
Mailing Address - Street 2:APARTMENT 218
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-6477
Mailing Address - Country:US
Mailing Address - Phone:609-805-1459
Mailing Address - Fax:
Practice Address - Street 1:18945 FM 2252 STE 115
Practice Address - Street 2:
Practice Address - City:GARDEN RIDGE
Practice Address - State:TX
Practice Address - Zip Code:78266-2797
Practice Address - Country:US
Practice Address - Phone:866-595-6379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0038069163W00000X
NJ26NR14890400163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse