Organization
FAMILY NURSE PRACTICE P.L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY RAYBURN NP-C (OWNER)
(480) 553-1547
Entity
Organization
Contact information
Practice address
1727 W EMELITA AVE APT 2104, MESA, AZ 85202-3168
(480) 553-1547
(480) 615-9039
Mailing address
1727 W EMELITA AVE APT 2104, MESA, AZ 85202-3168
(480) 553-1547
(480) 615-9039
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
—
—
261QC1800X
Corporate Health Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
261QR1300X
Rural Health Clinic/Center
—
—
305S00000X
Point of Service
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
06/07/2022
Last updated
06/10/2022
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