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NPI Code Detail

MEDICARE: MERCEDEZ SHANTELLE MIYOSHI RAINEY RN

MEDICARE: MERCEDEZ SHANTELLE MIYOSHI RAINEY RN
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
1163W00000XRegistered Nurse975403TX

General Provider Information

NPI Number : 1336797455
Entity Type Code : Individual
Provider Name (Legal Business Name) : MERCEDEZ SHANTELLE MIYOSHI RAINEY RN
Provider Business Mailing Address
First Line : 8608 FAWN HILL CT
Second Line :
City : FORT WORTH
State : TX
Zip : 76134-5365
Country : US
Telephone Number : 937-789-9449
Fax Number :
Provider Business Practice Location Address
First Line : 8608 FAWN HILL CT
Second Line :
City : FORT WORTH
State : TX
Zip : 76134-5365
Country : US
Telephone Number : 937-789-9449
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2019
Last Update Date : 09/02/2019

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