Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175M00000X | Lay Midwife | 30-049 | WI |
Y | 176B00000X | Midwife | 30-049 | WI |
NPI | 1003003773 |
---|---|
Provider Name | Andrea Raine |
First Address | Stevens Point, WI 54481-4503 |
Second Address | Stevens Point, WI 54481-4503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2007 |
Last Update Date | 26/09/2007 |