Healthcare Provider Details

I. General information

NPI: 1427219419
Provider Name (Legal Business Name): BONNIE LEA RAYBUCK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 NEW CASTLE RD
BUTLER PA
16001-2418
US

IV. Provider business mailing address

325 NEW CASTLE RD
BUTLER PA
16001-2418
US

V. Phone/Fax

Practice location:
  • Phone: 724-287-4781
  • Fax: 724-477-5036
Mailing address:
  • Phone: 724-287-4781
  • Fax: 724-477-5036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN326187L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: