Provider Demographics
NPI:1144625245
Name:KNIGHT, RAYLENE (CSFA)
Entity type:Individual
Prefix:
First Name:RAYLENE
Middle Name:
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:RAYLENE
Other - Middle Name:
Other - Last Name:LOOMIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4322 E JANICE WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-8101
Mailing Address - Country:US
Mailing Address - Phone:508-341-5153
Mailing Address - Fax:844-733-5163
Practice Address - Street 1:4322 E JANICE WAY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-8101
Practice Address - Country:US
Practice Address - Phone:508-341-5153
Practice Address - Fax:844-733-5163
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-31
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA112783246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant