Provider Demographics
NPI:1154962850
Name:RAYNER, RICHELLE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:RICHELLE
Middle Name:
Last Name:RAYNER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9435 TONAWANDA CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CLARENCE CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14032-9630
Mailing Address - Country:US
Mailing Address - Phone:716-597-1953
Mailing Address - Fax:
Practice Address - Street 1:9435 TONAWANDA CREEK RD
Practice Address - Street 2:
Practice Address - City:CLARENCE CENTER
Practice Address - State:NY
Practice Address - Zip Code:14032-9630
Practice Address - Country:US
Practice Address - Phone:716-597-1953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY716430163W00000X, 163WA0400X, 163WC0400X, 163WN0800X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience