Basic Information
| Provider Information | |||||||||
| NPI: | 1356712285 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAYMOND | ||||||||
| FirstName: | ALEYSA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13128 N. 94TH DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853814252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238768816 | ||||||||
| FaxNumber: | 6232980168 | ||||||||
| Practice Location | |||||||||
| Address1: | 13128 N. 94TH DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853814252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238768816 | ||||||||
| FaxNumber: | 6232980168 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2015 | ||||||||
| LastUpdateDate: | 01/30/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN203795 | AZ | N | Nursing Service Providers | Registered Nurse | 163WG0600X | 041.385179 | IL | N | Nursing Service Providers | Registered Nurse | Gerontology | 163WG0600X | AP9620 | AZ | Y | Nursing Service Providers | Registered Nurse | Gerontology | 363LG0600X | 209.013442 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.