Provider Demographics
NPI:1912603812
Name:HANCOCK, RAE LYNN
Entity Type:Individual
Prefix:
First Name:RAE
Middle Name:LYNN
Last Name:HANCOCK
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 1:3741 WENZLER DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-3365
Mailing Address - Country:US
Mailing Address - Phone:937-479-6104
Mailing Address - Fax:
Practice Address - Street 1:3741 WENZLER DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-3365
Practice Address - Country:US
Practice Address - Phone:937-479-6104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide