Healthcare Provider Details

I. General information

NPI: 1780191353
Provider Name (Legal Business Name): RAYNARD STERLING NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2018
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 ROSE HILL LN
LAWRENCEVILLE GA
30044-5714
US

IV. Provider business mailing address

2161 VAN WICK ST
LOS ANGELES CA
90047-4644
US

V. Phone/Fax

Practice location:
  • Phone: 310-351-2643
  • Fax:
Mailing address:
  • Phone: 310-351-2643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number736881
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2984873
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN298483
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: