Provider Demographics
NPI:1700510377
Name:RAINSONG, STEPHANE COSBY (PA-C)
Entity type:Individual
Prefix:
First Name:STEPHANE
Middle Name:COSBY
Last Name:RAINSONG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 CENTENNIAL RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2353
Mailing Address - Country:US
Mailing Address - Phone:760-567-8793
Mailing Address - Fax:
Practice Address - Street 1:3655 E 104TH AVE UNIT A
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-6136
Practice Address - Country:US
Practice Address - Phone:303-254-8500
Practice Address - Fax:303-453-4994
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA0007436363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant