Healthcare Provider Details

I. General information

NPI: 1427912120
Provider Name (Legal Business Name): AMY BRAY LLC, CNA, DOULA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 S CRAPO RD
ITHACA MI
48847-9564
US

IV. Provider business mailing address

3023 S CRAPO RD
ITHACA MI
48847-9564
US

V. Phone/Fax

Practice location:
  • Phone: 989-330-7689
  • Fax:
Mailing address:
  • Phone: 989-330-7689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number230015572210811
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: