Provider Demographics
NPI:1619606506
Name:FAMILY NURSE PRACTICE P.L.L.C.
Entity type:Organization
Organization Name:FAMILY NURSE PRACTICE P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYBURN
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:480-553-1547
Mailing Address - Street 1:1727 W EMELITA AVE APT 2104
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-3168
Mailing Address - Country:US
Mailing Address - Phone:480-553-1547
Mailing Address - Fax:480-615-9039
Practice Address - Street 1:1727 W EMELITA AVE APT 2104
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-3168
Practice Address - Country:US
Practice Address - Phone:480-553-1547
Practice Address - Fax:480-615-9039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No305S00000XManaged Care OrganizationsPoint of Service
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies