Provider Demographics
NPI:1356715056
Name:WRAY, NICOLA JAYNE (PCD, CLC)
Entity type:Individual
Prefix:MRS
First Name:NICOLA
Middle Name:JAYNE
Last Name:WRAY
Suffix:
Gender:F
Credentials:PCD, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 FIRST ST
Mailing Address - Street 2:APT 425
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-1676
Mailing Address - Country:US
Mailing Address - Phone:703-606-6033
Mailing Address - Fax:
Practice Address - Street 1:1200 FIRST ST
Practice Address - Street 2:APT 425
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1676
Practice Address - Country:US
Practice Address - Phone:703-606-6033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207105174N00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN