Provider Demographics
NPI:1811341985
Name:RAY, MONA AMANDA (RN)
Entity type:Individual
Prefix:MRS
First Name:MONA
Middle Name:AMANDA
Last Name:RAY
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 1:801 JONESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BOSTIC
Mailing Address - State:NC
Mailing Address - Zip Code:28018-7613
Mailing Address - Country:US
Mailing Address - Phone:828-245-9956
Mailing Address - Fax:
Practice Address - Street 1:801 JONESTOWN RD
Practice Address - Street 2:
Practice Address - City:BOSTIC
Practice Address - State:NC
Practice Address - Zip Code:28018-7613
Practice Address - Country:US
Practice Address - Phone:828-245-9956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC140420163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC140420OtherNC BOARD OF NURSING