Provider Demographics
NPI:1730663980
Name:BRAY, RENEA (LPN)
Entity Type:Individual
Prefix:MS
First Name:RENEA
Middle Name:
Last Name:BRAY
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 1:2133 S CARROLLTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-2950
Mailing Address - Country:US
Mailing Address - Phone:504-635-7455
Mailing Address - Fax:
Practice Address - Street 1:200 BROADWAY ST STE 230
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-3544
Practice Address - Country:US
Practice Address - Phone:504-988-9000
Practice Address - Fax:504-988-9099
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-23
Last Update Date:2018-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20102458164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse