Individual
RAVEN DANIELLE LYLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 HAWTHORNE LN, CHARLOTTE, NC 28204-2515
(704) 384-4274
Mailing address
355 OLD SPANISH TRL, JACKSON, MS 39212-3210
(601) 405-1782
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
904663
MS
367500000X
Certified Registered Nurse Anesthetist
Primary
0024186691
VA
367500000X
Certified Registered Nurse Anesthetist
6828
NC
Other
Enumeration date
02/07/2022
Last updated
03/27/2026
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