Provider Demographics
NPI:1467952325
Name:RAYNES, LAVETA SUE
Entity Type:Individual
Prefix:
First Name:LAVETA
Middle Name:SUE
Last Name:RAYNES
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 1:221 COUNTY ROAD 1914
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:TX
Mailing Address - Zip Code:75563-4111
Mailing Address - Country:US
Mailing Address - Phone:903-559-3433
Mailing Address - Fax:
Practice Address - Street 1:221 COUNTY ROAD 1914
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:TX
Practice Address - Zip Code:75563-4111
Practice Address - Country:US
Practice Address - Phone:903-559-3433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-17
Last Update Date:2018-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX323395164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse