Provider Demographics
NPI:1407094527
Name:CRAYTON, ENOLA GAY (LPN)
Entity type:Individual
Prefix:
First Name:ENOLA
Middle Name:GAY
Last Name:CRAYTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 S 28TH ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-4903
Mailing Address - Country:US
Mailing Address - Phone:580-309-0943
Mailing Address - Fax:
Practice Address - Street 1:707 S 28TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-4903
Practice Address - Country:US
Practice Address - Phone:580-309-0943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0020585164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse