Provider Demographics
NPI:1174063119
Name:RAYNOR-PIGFORD, LATONIA
Entity type:Individual
Prefix:
First Name:LATONIA
Middle Name:
Last Name:RAYNOR-PIGFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-1604
Mailing Address - Country:US
Mailing Address - Phone:919-866-9722
Mailing Address - Fax:
Practice Address - Street 1:502 CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-1604
Practice Address - Country:US
Practice Address - Phone:919-866-9722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X, 374U00000X, 3747P1801X
NC374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion
No374J00000XNursing Service Related ProvidersDoula
No374U00000XNursing Service Related ProvidersHome Health Aide