Provider Demographics
NPI:1528841343
Name:GRAY, RHONDA DESHAUN (LPN)
Entity type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:DESHAUN
Last Name:GRAY
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 1:9598 AMARILLO CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-2201
Mailing Address - Country:US
Mailing Address - Phone:513-238-1462
Mailing Address - Fax:
Practice Address - Street 1:9598 AMARILLO CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-2201
Practice Address - Country:US
Practice Address - Phone:513-238-1462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-106041164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse