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General NPI Number Information
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NPI Number | 1780191353
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Entity Type | Individual
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Provider Name | RAYNARD STERLING NP
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Gender | Male
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Dates
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Enumeration Date | 01/04/2018
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Last Update Date | 10/18/2021
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Provider Practice Location Address
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Address Line | 545 ROSE HILL LN
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-5714
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Country | US
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Telephone | 310-351-2643
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Fax |
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Provider Business Mailing Address
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Address Line | 2161 VAN WICK ST
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City | LOS ANGELES
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State | CA
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Zip | 90047-4644
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Country | US
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Telephone | 310-351-2643
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP2201X
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Taxonomy Name | Ambulatory Care Registered Nurse
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License Number | 736881
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN2984873
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN298483
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License Number State | GA
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