Basic Information
Provider Information
NPI: 1003003773
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RAINE
FirstName: ANDREA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CPM, LM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2108 CHURCH ST
Address2:  
City: STEVENS POINT
State: WI
PostalCode: 544814503
CountryCode: US
TelephoneNumber: 7153451222
FaxNumber:  
Practice Location
Address1: 2108 CHURCH ST
Address2:  
City: STEVENS POINT
State: WI
PostalCode: 544814503
CountryCode: US
TelephoneNumber: 7153451222
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/26/2007
LastUpdateDate: 09/26/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
175M00000X30-049WIN Other Service ProvidersMidwife, Lay 
176B00000X30-049WIY Other Service ProvidersMidwife 

No ID Information.


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