MEDICARE: RABANY CLAYBORN NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	190291-30	WI
2	363LF0000X	Family Nurse Practitioner	6067-33	WI
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	6067-33	WI

General Provider Information

NPI Number	:	1003163460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RABANY CLAYBORN NP-C

Provider Business Mailing Address
First Line	:	2945 N 53RD ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-1616
Country	:	US
Telephone Number	:	414-581-9199
Fax Number	:

Provider Business Practice Location Address
First Line	:	3522 W LISBON AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53208-1953
Country	:	US
Telephone Number	:	414-935-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2012
Last Update Date	:	06/29/2021

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