Provider Demographics
NPI:1285695890
Name:RAINS, VICKIE SUE (REGISTERED NURSE)
Entity type:Individual
Prefix:MS
First Name:VICKIE
Middle Name:SUE
Last Name:RAINS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4707 TURNER AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53716-2249
Mailing Address - Country:US
Mailing Address - Phone:608-223-9049
Mailing Address - Fax:
Practice Address - Street 1:4707 TURNER AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53716-2249
Practice Address - Country:US
Practice Address - Phone:608-223-9049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38201800Medicaid