Provider Demographics
NPI:1285886770
Name:RAINIER FAMILY PRACTICE PLLC
Entity type:Organization
Organization Name:RAINIER FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER/ARNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-259-8300
Mailing Address - Street 1:1408 STATE AVE NE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4481
Mailing Address - Country:US
Mailing Address - Phone:360-705-2273
Mailing Address - Fax:360-357-2274
Practice Address - Street 1:1408 STATE AVE NE
Practice Address - Street 2:SUITE 111
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4481
Practice Address - Country:US
Practice Address - Phone:360-705-2273
Practice Address - Fax:360-357-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006938261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center