Provider Demographics
NPI:1245460153
Name:RAY, RACHAEL KIMBERLY (LPN)
Entity type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:KIMBERLY
Last Name:RAY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 COUNTESS AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14211-2101
Mailing Address - Country:US
Mailing Address - Phone:716-335-6075
Mailing Address - Fax:
Practice Address - Street 1:43 COUNTESS AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211-2101
Practice Address - Country:US
Practice Address - Phone:716-335-6075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10 295493164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse