Basic Information
Provider Information | |||||||||
NPI: | 1720132426 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RAIRIGH | ||||||||
FirstName: | JASON | ||||||||
MiddleName: | ROBERT | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | RN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | RAIRIGH | ||||||||
OtherFirstName: | JASON | ||||||||
OtherMiddleName: | ROBERT | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | RN | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 80567 COUNTY ROAD 15 | ||||||||
Address2: |   | ||||||||
City: | MITCHELL | ||||||||
State: | NE | ||||||||
PostalCode: | 693572129 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3086142464 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 4110 AVENUE D | ||||||||
Address2: |   | ||||||||
City: | SCOTTSBLUFF | ||||||||
State: | NE | ||||||||
PostalCode: | 693614650 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3086353171 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/22/2007 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WH0200X | 51856 | NE | Y |   | Nursing Service Providers | Registered Nurse | Home Health |
No ID Information.