Provider Demographics
NPI:1164036687
Name:GRAY-DUNN, CARMEN (LPN)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:GRAY-DUNN
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 1:1900 W MARKET ST STE H
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-6927
Mailing Address - Country:US
Mailing Address - Phone:234-901-2590
Mailing Address - Fax:
Practice Address - Street 1:1900 W MARKET ST STE H
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-6927
Practice Address - Country:US
Practice Address - Phone:234-901-2590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN157867164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse