Provider Demographics
NPI:1598743536
Name:GRAY, JEANINE AIMEE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JEANINE
Middle Name:AIMEE
Last Name:GRAY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 D KOELSCH CIR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818
Mailing Address - Country:US
Mailing Address - Phone:808-422-7764
Mailing Address - Fax:
Practice Address - Street 1:1960 KOELSCH CIR
Practice Address - Street 2:APARTMENT D
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-3538
Practice Address - Country:US
Practice Address - Phone:808-422-7764
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN065251164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse