Provider Demographics
NPI:1669185401
Name:RAYNER, LADONNA
Entity type:Individual
Prefix:
First Name:LADONNA
Middle Name:
Last Name:RAYNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 W 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-1727
Mailing Address - Country:US
Mailing Address - Phone:219-942-2170
Mailing Address - Fax:
Practice Address - Street 1:2901 W 37TH AVE
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-1727
Practice Address - Country:US
Practice Address - Phone:219-942-2170
Practice Address - Fax:219-942-7781
Is Sole Proprietor?:No
Enumeration Date:2022-12-26
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27045410A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse