Provider Demographics
NPI:1548535743
Name:GRAY, ARIELLE D (STNA)
Entity type:Individual
Prefix:MISS
First Name:ARIELLE
Middle Name:D
Last Name:GRAY
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 NEWMAN AVE
Mailing Address - Street 2:APT 307
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-5166
Mailing Address - Country:US
Mailing Address - Phone:216-315-8746
Mailing Address - Fax:
Practice Address - Street 1:1510 NEWMAN AVE
Practice Address - Street 2:APT 307
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-5166
Practice Address - Country:US
Practice Address - Phone:216-315-8746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400795960808376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide