Provider Demographics
NPI:1427323914
Name:GRAY, JEANA RENE (STNA)
Entity type:Individual
Prefix:
First Name:JEANA
Middle Name:RENE
Last Name:GRAY
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 BISHOPGATE DR APT 306
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-4362
Mailing Address - Country:US
Mailing Address - Phone:678-663-0551
Mailing Address - Fax:
Practice Address - Street 1:73 BISHOPGATE DR APT 306
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-4362
Practice Address - Country:US
Practice Address - Phone:678-663-0551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0014181982164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse