Provider Demographics
NPI:1275893539
Name:GREY, ROXANN LINDA (PN M-IV)
Entity Type:Individual
Prefix:MS
First Name:ROXANN
Middle Name:LINDA
Last Name:GREY
Suffix:
Gender:F
Credentials:PN M-IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 OREGON DR
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-4433
Mailing Address - Country:US
Mailing Address - Phone:937-520-4268
Mailing Address - Fax:
Practice Address - Street 1:313 OREGON DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-4433
Practice Address - Country:US
Practice Address - Phone:937-520-4268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH148938164X00000X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse