Provider Demographics
NPI:1992310965
Name:AMAR, RAYVEN
Entity type:Individual
Prefix:
First Name:RAYVEN
Middle Name:
Last Name:AMAR
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 1:2135 HARSH AVE SE APT 2A
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-7180
Mailing Address - Country:US
Mailing Address - Phone:234-804-6361
Mailing Address - Fax:
Practice Address - Street 1:2135 HARSH AVE SE APT 2A
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-7180
Practice Address - Country:US
Practice Address - Phone:234-804-6361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide