Provider Demographics
NPI:1164546776
Name:WHEAT, RAYLENE MAE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:RAYLENE
Middle Name:MAE
Last Name:WHEAT
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 PRINCETON DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-3751
Mailing Address - Country:US
Mailing Address - Phone:850-458-5534
Mailing Address - Fax:
Practice Address - Street 1:5192 BAYOU BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2102
Practice Address - Country:US
Practice Address - Phone:850-484-5040
Practice Address - Fax:850-475-5507
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9206255163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management