Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 6067-33 | WI |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 6067-33 | WI |
NPI | 1003163460 |
---|---|
Provider Name | Rabany Clayborn |
First Address | Milwaukee, WI 53210-1616 |
Second Address | Milwaukee, WI 53208-1953 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2012 |
Last Update Date | 29/06/2021 |