Provider Demographics
NPI:1477827921
Name:HOSBROUGH, RAYE (CNA)
Entity Type:Individual
Prefix:MRS
First Name:RAYE
Middle Name:
Last Name:HOSBROUGH
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 S. HANOVER
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:IL
Mailing Address - Zip Code:61548
Mailing Address - Country:US
Mailing Address - Phone:309-360-3181
Mailing Address - Fax:
Practice Address - Street 1:222 S HANOVER ST
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:IL
Practice Address - Zip Code:61548-9779
Practice Address - Country:US
Practice Address - Phone:309-360-3181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker