Provider Demographics
NPI:1588278485
Name:GRAY, DEBORAH S
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:S
Last Name:GRAY
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 1:1050 NUTMEG SQ N
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1827
Mailing Address - Country:US
Mailing Address - Phone:937-335-3492
Mailing Address - Fax:
Practice Address - Street 1:1050 NUTMEG SQ N
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1827
Practice Address - Country:US
Practice Address - Phone:937-335-3492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2110834374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide