Provider Demographics
NPI:1699382580
Name:RAINES, PAMELA DAWN (APRN)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:DAWN
Last Name:RAINES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 W MCCREIGHT AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-1890
Mailing Address - Country:US
Mailing Address - Phone:937-523-9940
Mailing Address - Fax:937-523-9935
Practice Address - Street 1:100 W MCCREIGHT AVE STE 110
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1890
Practice Address - Country:US
Practice Address - Phone:937-523-9940
Practice Address - Fax:937-523-9935
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0027563363LP2300X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care