Healthcare Provider Details

I. General information

NPI: 1932065885
Provider Name (Legal Business Name): RAQUEL JENESE CLAYTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6806 BONNIE RIDGE DR APT 102
BALTIMORE MD
21209-4857
US

IV. Provider business mailing address

6806 BONNIE RIDGE DR APT 102
BALTIMORE MD
21209-4857
US

V. Phone/Fax

Practice location:
  • Phone: 954-864-8400
  • Fax:
Mailing address:
  • Phone: 954-864-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License NumberRN9398344
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: