Provider Demographics
NPI:1275155194
Name:RAIMI, TEIBATU SANDRA
Entity Type:Individual
Prefix:
First Name:TEIBATU
Middle Name:SANDRA
Last Name:RAIMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 DEER CREEK DR STE 11
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-8089
Mailing Address - Country:US
Mailing Address - Phone:614-772-5497
Mailing Address - Fax:
Practice Address - Street 1:1755 DEER CREEK DR STE 11
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-8089
Practice Address - Country:US
Practice Address - Phone:614-772-5497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN475451163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse