Provider Demographics
NPI:1386162980
Name:RAINES, RITA Y (FNP)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:Y
Last Name:RAINES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:CAMPOBELLO
Mailing Address - State:SC
Mailing Address - Zip Code:29322-9212
Mailing Address - Country:US
Mailing Address - Phone:284-589-7748
Mailing Address - Fax:
Practice Address - Street 1:551 GRANBY LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-4655
Practice Address - Country:US
Practice Address - Phone:864-530-2008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-02
Last Update Date:2017-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF06172631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine