Provider Demographics
NPI:1932529336
Name:RAYBURN, DALE ANN (LPN)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:ANN
Last Name:RAYBURN
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 1:213 21ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2927
Mailing Address - Country:US
Mailing Address - Phone:360-596-6400
Mailing Address - Fax:360-596-6401
Practice Address - Street 1:LINCOLN 231 21ST AVE. SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2927
Practice Address - Country:US
Practice Address - Phone:360-596-6400
Practice Address - Fax:360-596-6401
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00047451164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse