Provider Demographics
NPI:1851930036
Name:RAY, BIANCA (FNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:BIANCA
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 E 194TH ST UNIT 2E
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60425-2153
Mailing Address - Country:US
Mailing Address - Phone:708-870-8562
Mailing Address - Fax:
Practice Address - Street 1:829 E 194TH ST UNIT 2E
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IL
Practice Address - Zip Code:60425-2153
Practice Address - Country:US
Practice Address - Phone:708-870-8562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-05
Last Update Date:2020-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041397280163W00000X
IL209017003363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse