Provider Demographics
NPI:1417512120
Name:RAYMO, JOSHLAN S
Entity Type:Individual
Prefix:
First Name:JOSHLAN
Middle Name:S
Last Name:RAYMO
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 1:610 UPTOWN BLVD STE 267
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-3528
Mailing Address - Country:US
Mailing Address - Phone:318-209-0204
Mailing Address - Fax:800-866-0799
Practice Address - Street 1:610 UPTOWN BLVD STE 267
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-3528
Practice Address - Country:US
Practice Address - Phone:318-209-0204
Practice Address - Fax:800-866-0799
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX340803164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse