Provider Demographics
NPI:1730961814
Name:GRAY, ELIZABETH D
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:D
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 1:33083 LOGAN HORNS MILL RD
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-8497
Mailing Address - Country:US
Mailing Address - Phone:740-385-0571
Mailing Address - Fax:
Practice Address - Street 1:20680 WOODARD RD
Practice Address - Street 2:
Practice Address - City:NEW PLYMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45654-9637
Practice Address - Country:US
Practice Address - Phone:740-385-8351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0239666374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide