Provider Demographics
NPI:1013247501
Name:RAYNER, MALKIA (RN)
Entity Type:Individual
Prefix:
First Name:MALKIA
Middle Name:
Last Name:RAYNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 OLD RALEIGH RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-5891
Mailing Address - Country:US
Mailing Address - Phone:910-379-4770
Mailing Address - Fax:
Practice Address - Street 1:4406 OLD WAKE FOREST RD
Practice Address - Street 2:SUITE 201
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-2527
Practice Address - Country:US
Practice Address - Phone:919-790-7663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC234038163W00000X
NC64167164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse