Provider Demographics
NPI:1548086739
Name:RAAB, MIA (BSN, RN, PHN)
Entity type:Individual
Prefix:MRS
First Name:MIA
Middle Name:
Last Name:RAAB
Suffix:
Gender:F
Credentials:BSN, RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-2318
Mailing Address - Country:US
Mailing Address - Phone:530-543-2337
Mailing Address - Fax:530-543-2342
Practice Address - Street 1:3501 SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-2318
Practice Address - Country:US
Practice Address - Phone:530-543-2337
Practice Address - Fax:530-543-2342
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA723456163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool