Provider Demographics
NPI:1023827714
Name:RAYBOURN, MARCY LYNN (LAC)
Entity type:Individual
Prefix:MS
First Name:MARCY
Middle Name:LYNN
Last Name:RAYBOURN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3940 W CHARTER OAK RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-2980
Mailing Address - Country:US
Mailing Address - Phone:602-551-0288
Mailing Address - Fax:
Practice Address - Street 1:11225 N 28TH DR STE D115B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-5609
Practice Address - Country:US
Practice Address - Phone:623-551-0288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ000199171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist