Provider Demographics
NPI:1982819264
Name:RAY, FERN MARIE
Entity Type:Individual
Prefix:MRS
First Name:FERN
Middle Name:MARIE
Last Name:RAY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:FERN
Other - Middle Name:MARIE
Other - Last Name:NEZ-RAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 3309
Mailing Address - Street 2:
Mailing Address - City:INDIAN WELLS
Mailing Address - State:AZ
Mailing Address - Zip Code:86031
Mailing Address - Country:US
Mailing Address - Phone:928-521-2546
Mailing Address - Fax:
Practice Address - Street 1:NAVAJO RESERVATION
Practice Address - Street 2:10 MILES WEST OF WHITE CONE FROM ROAD 77
Practice Address - City:INDIAN WELLS
Practice Address - State:AZ
Practice Address - Zip Code:86031
Practice Address - Country:US
Practice Address - Phone:928-521-2546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered372600000XNursing Service Related ProvidersAdult Companion
Not Answered372500000XNursing Service Related ProvidersChore Provider
Not Answered3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Not Answered374U00000XNursing Service Related ProvidersHome Health Aide
Not Answered376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ777732OtherSTATE PROVIDE ID