Provider Demographics
NPI:1447283098
Name:RAYNOR, CAROL SUE
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:SUE
Last Name:RAYNOR
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:SUE
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 986513
Mailing Address - Street 2:DEPARTMENT 100
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02298-6513
Mailing Address - Country:US
Mailing Address - Phone:910-219-8326
Mailing Address - Fax:910-939-4269
Practice Address - Street 1:114 MEMORIAL DR STE A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6328
Practice Address - Country:US
Practice Address - Phone:910-353-0700
Practice Address - Fax:910-353-5305
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC117615363LA2100X
NC201761363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCN905AMedicare UPIN
NC3406870OtherAMBULANCE MEDICAID
NCQ04511Medicare UPIN
NC340042Medicare ID - Type Unspecified
NC3400042Medicaid