Individual
CIERA RAVEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
205 E CHURCH ST, AMERICUS, GA 31709-3603
(229) 938-1528
Mailing address
205 E CHURCH ST, AMERICUS, GA 31709-3603
(229) 938-1528
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN091528
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
82-2528442
IRS
—
Enumeration date
11/01/2018
Last updated
11/01/2018
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