Provider Demographics
NPI:1730681313
Name:RAYRAY, NICOLLETTE
Entity type:Individual
Prefix:
First Name:NICOLLETTE
Middle Name:
Last Name:RAYRAY
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 1:921 S. 8TH AVE.
Mailing Address - Street 2:STOP 8253
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83209
Mailing Address - Country:US
Mailing Address - Phone:208-282-4726
Mailing Address - Fax:
Practice Address - Street 1:921 S. 8TH AVE.
Practice Address - Street 2:STOP 8253
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83209
Practice Address - Country:US
Practice Address - Phone:208-282-4726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other