Provider Demographics
NPI:1053739540
Name:RAYMER, MARILYN IDA (RN)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:IDA
Last Name:RAYMER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:BEHREND
Other - Last Name:RAYMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 15
Mailing Address - Street 2:2112 303RD PL
Mailing Address - City:OCEAN PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98640-0015
Mailing Address - Country:US
Mailing Address - Phone:360-665-2685
Mailing Address - Fax:
Practice Address - Street 1:2204 PACIFIC AVE N
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:WA
Practice Address - Zip Code:98631-3300
Practice Address - Country:US
Practice Address - Phone:360-642-3787
Practice Address - Fax:360-642-2096
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00043550163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse