Provider Demographics
NPI:1811250517
Name:MANSARAY, AL SULLAY (LPN)
Entity type:Individual
Prefix:MR
First Name:AL
Middle Name:SULLAY
Last Name:MANSARAY
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 1:3978 FOREST EDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1018
Mailing Address - Country:US
Mailing Address - Phone:614-515-1357
Mailing Address - Fax:
Practice Address - Street 1:3978 FOREST EDGE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-1018
Practice Address - Country:US
Practice Address - Phone:614-515-1357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH149299164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse