Provider Demographics
NPI:1457996282
Name:BRAY, LORI ELLEN
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ELLEN
Last Name:BRAY
Suffix:
Gender:F
Credentials:
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 622
Mailing Address - Street 2:
Mailing Address - City:ROSELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32957-0622
Mailing Address - Country:US
Mailing Address - Phone:772-538-2857
Mailing Address - Fax:
Practice Address - Street 1:8520 US HIGHWAY 1 APT B12
Practice Address - Street 2:
Practice Address - City:MICCO
Practice Address - State:FL
Practice Address - Zip Code:32976-2616
Practice Address - Country:US
Practice Address - Phone:772-538-2857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula