Doctor Name: | REBA DALE TRAYLOR |
NPI Number: | 1043574999 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 18019 |
Business Practice Address: | 1898 Fort Rd Sheridan, WY - 828018320 |
Business Phone Number: | 3076753786 |
Business Fax Number: | |
Mailing Address: | 1898 Fort Rd, SHERIDAN |
State: | WY |
Postal Code: | 828018320 |
Phone Number: | 3076753786 |
Fax Number: | |
NPI Enumeration Date: | 06/26/2012 |
NPI Last Update Date: | 06/26/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WH0200X |
License Number: | 18019 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Home Health |
Taxonomy Definition: |