Provider Demographics
NPI:1730871021
Name:RAYFORD, ROSELYN RENEE
Entity type:Individual
Prefix:
First Name:ROSELYN
Middle Name:RENEE
Last Name:RAYFORD
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 1:1854 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-4817
Mailing Address - Country:US
Mailing Address - Phone:419-787-1615
Mailing Address - Fax:
Practice Address - Street 1:1854 LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-4817
Practice Address - Country:US
Practice Address - Phone:419-787-1615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN310734163W00000X
171W00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No171W00000XOther Service ProvidersContractor
No374U00000XNursing Service Related ProvidersHome Health Aide