Provider Demographics
NPI:1629405659
Name:GRAY, LADONNA CRYSTAL (STNA)
Entity Type:Individual
Prefix:
First Name:LADONNA
Middle Name:CRYSTAL
Last Name:GRAY
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 W GALBRAITH RD APT 4A
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-4251
Mailing Address - Country:US
Mailing Address - Phone:513-693-2490
Mailing Address - Fax:
Practice Address - Street 1:2610 W GALBRAITH RD APT 4A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-4251
Practice Address - Country:US
Practice Address - Phone:513-693-2490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400240750503376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide