Provider Demographics
NPI:1962422667
Name:RAAB, JOSEPHINE (NP)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:RAAB
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N 8TH ST
Mailing Address - Street 2:P.O. BOX 1208
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-6208
Mailing Address - Country:US
Mailing Address - Phone:716-372-9399
Mailing Address - Fax:716-373-5530
Practice Address - Street 1:415 N 8TH STREET
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-2237
Practice Address - Country:US
Practice Address - Phone:716-372-9399
Practice Address - Fax:716-373-5530
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302991363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9590025OtherIHA
NY02107335Medicaid
NY302991OtherLICENSE
NY00026494302OtherUNIVERA
NYP019302991OtherBLUE CHOICE
NY00056056604OtherBLUE CROSS
NY00056056604OtherBLUE CROSS
NYRB7715Medicare PIN