Provider Demographics
NPI:1982432001
Name:GRAY, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GRAY
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 1:13113 LEFFINGWELL RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:44401-9642
Mailing Address - Country:US
Mailing Address - Phone:330-540-8537
Mailing Address - Fax:
Practice Address - Street 1:1920 CHURCHILL RD STE 104
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-2484
Practice Address - Country:US
Practice Address - Phone:855-213-1511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide