Provider Demographics
NPI:1215009105
Name:RAYNE, NANCY (MS, PMH NP, CNS, BC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:RAYNE
Suffix:
Gender:F
Credentials:MS, PMH NP, CNS, BC
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:L BROAD
Other - Last Name:RAYNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMH NP, CNS, BC
Mailing Address - Street 1:7325 STATE ROUTE 5
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-3435
Mailing Address - Country:US
Mailing Address - Phone:315-859-1973
Mailing Address - Fax:
Practice Address - Street 1:7325 STATE ROUTE 5
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323
Practice Address - Country:US
Practice Address - Phone:315-859-1973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF402381363LP0808X
NYF402381-1364SP0809X
NY338078-1163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult