Provider Demographics
NPI:1073039004
Name:GRAY, PAMELA ELAINE (STNA)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ELAINE
Last Name:GRAY
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:ELAINE
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:STNA , MA,HHA,PCA
Mailing Address - Street 1:821 BERKELEY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2902
Mailing Address - Country:US
Mailing Address - Phone:614-360-4789
Mailing Address - Fax:
Practice Address - Street 1:821 BERKELEY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2902
Practice Address - Country:US
Practice Address - Phone:614-360-4789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide