Healthcare Provider Details

I. General information

NPI: 1013247501
Provider Name (Legal Business Name): MALKIA RAYNER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2010
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4406 OLD WAKE FOREST RD SUITE 201
RALEIGH NC
27609-2527
US

IV. Provider business mailing address

1970 OLD RALEIGH RD
CLINTON NC
28328-5891
US

V. Phone/Fax

Practice location:
  • Phone: 919-790-7663
  • Fax:
Mailing address:
  • Phone: 910-379-4770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number234038
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number64167
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: