1609042456 NPI number — MRS. MICHELE DIANE RAGER MS, RD-AP, LDN, CNSC

Table of content: MRS. MICHELE DIANE RAGER MS, RD-AP, LDN, CNSC (NPI 1609042456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609042456 NPI number — MRS. MICHELE DIANE RAGER MS, RD-AP, LDN, CNSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAGER
Provider First Name:
MICHELE
Provider Middle Name:
DIANE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, RD-AP, LDN, CNSC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609042456
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 HIGHLAND LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEWICKLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15143-1040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-322-5667
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11565 PERRY HWY
Provider Second Line Business Practice Location Address:
SUITE 1B
Provider Business Practice Location Address City Name:
WEXFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15090-8799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-322-5667
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  DN003353 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X , with the licence number: 930993 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 103066500 0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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