Individual
NICHOLE CHRISTINE RAVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1404 EASTLAND DR STE 204, BLOOMINGTON, IL 61701-7904
(309) 662-8813
Mailing address
1404 EASTLAND DR STE 204, BLOOMINGTON, IL 61701-7904
(309) 662-8813
(309) 662-6835
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
085009019
IL
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/21/2015
Last updated
05/24/2024
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