Provider Demographics
NPI:1215350046
Name:BUTLER, RAYLAINE
Entity type:Individual
Prefix:
First Name:RAYLAINE
Middle Name:
Last Name:BUTLER
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 1:682 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45419-1149
Mailing Address - Country:US
Mailing Address - Phone:937-546-1409
Mailing Address - Fax:937-237-6307
Practice Address - Street 1:5954 LONGFORD RD
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-2943
Practice Address - Country:US
Practice Address - Phone:937-237-6300
Practice Address - Fax:937-237-6307
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH149851163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH149851OtherSTATE OF OHIO RN LICENSE NUMBER