Provider Demographics
NPI:1376395640
Name:RAY, LACRESHA ANNETTE
Entity Type:Individual
Prefix:
First Name:LACRESHA
Middle Name:ANNETTE
Last Name:RAY
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 1:3430 E BRAINARD RD APT 303
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4247
Mailing Address - Country:US
Mailing Address - Phone:330-293-1823
Mailing Address - Fax:
Practice Address - Street 1:3430 E BRAINARD RD APT 303
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:OH
Practice Address - Zip Code:44122-4247
Practice Address - Country:US
Practice Address - Phone:330-293-1823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider