Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MW264 | FL |
NPI | 1134470826 |
---|---|
Provider Name | Ms. Mary Louise Rainer |
First Address | Fort Pierce, FL 34950-8101 |
Second Address | Fort Pierce, FL 34950-8101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2012 |
Last Update Date | 06/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006593100 | (05) | FL |