Provider Demographics
NPI:1760837090
Name:GRIER, WANDA RAY (LPN)
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:RAY
Last Name:GRIER
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 1:22370 RIVER RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-4694
Mailing Address - Country:US
Mailing Address - Phone:248-579-7869
Mailing Address - Fax:
Practice Address - Street 1:22370 RIVER RIDGE TRL
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-4694
Practice Address - Country:US
Practice Address - Phone:248-579-7869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-23
Last Update Date:2016-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
MI4703065929164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst