Provider Demographics
NPI:1023286143
Name:BRAY, MICHELLE RAE (LPN)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:RAE
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:PO BOX 294
Mailing Address - Street 2:
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45648-0294
Mailing Address - Country:US
Mailing Address - Phone:740-876-4215
Mailing Address - Fax:
Practice Address - Street 1:1601 HARRISONVILLE AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-5012
Practice Address - Country:US
Practice Address - Phone:740-876-4215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 103185164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse