Provider Demographics
NPI:1346453123
Name:GRAY, CORYNN ALVILDA (CNA)
Entity Type:Individual
Prefix:MS
First Name:CORYNN
Middle Name:ALVILDA
Last Name:GRAY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 SALISBURY CT
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9682
Mailing Address - Country:US
Mailing Address - Phone:240-529-3718
Mailing Address - Fax:
Practice Address - Street 1:2581 WASHINGTON RD
Practice Address - Street 2:SUITE 235
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-2564
Practice Address - Country:US
Practice Address - Phone:800-355-1225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA9993401376K00000X
MDA00081172376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide