Provider Demographics
NPI:1417673815
Name:FRY, LAYNIE ROSE
Entity Type:Individual
Prefix:
First Name:LAYNIE
Middle Name:ROSE
Last Name:FRY
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 1:5916 WALNUT CIR APT A2
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-6627
Mailing Address - Country:US
Mailing Address - Phone:567-698-2393
Mailing Address - Fax:
Practice Address - Street 1:5916 WALNUT CIR APT A2
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-6627
Practice Address - Country:US
Practice Address - Phone:567-698-2393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant