Provider Demographics
NPI:1013762392
Name:BRAY, MARCUS (LPN)
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:
Last Name:BRAY
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8130 CHAPEL STONE RD
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-9229
Mailing Address - Country:US
Mailing Address - Phone:614-286-8015
Mailing Address - Fax:
Practice Address - Street 1:3359 ROBIN HILL CT W
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-3523
Practice Address - Country:US
Practice Address - Phone:614-286-8015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH157594164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse