Provider Demographics
NPI:1831656222
Name:GRAY, JAVONNE RENEE' (CNM)
Entity Type:Individual
Prefix:
First Name:JAVONNE
Middle Name:RENEE'
Last Name:GRAY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JAVONNE
Other - Middle Name:RENEE'
Other - Last Name:WOODLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33595 BAINBRIDGE RD STE 200A
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2981
Mailing Address - Country:US
Mailing Address - Phone:216-230-8840
Mailing Address - Fax:
Practice Address - Street 1:33595 BAINBRIDGE RD STE 200A
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2981
Practice Address - Country:US
Practice Address - Phone:216-230-8840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH019369367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife