Provider Demographics
NPI:1447797436
Name:GRAYSON, WENONA
Entity Type:Individual
Prefix:
First Name:WENONA
Middle Name:
Last Name:GRAYSON
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 1:10115 DAYCREST DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45246-4873
Mailing Address - Country:US
Mailing Address - Phone:513-860-0399
Mailing Address - Fax:
Practice Address - Street 1:10115 DAYCREST DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45246-4873
Practice Address - Country:US
Practice Address - Phone:513-485-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle