Healthcare Provider Details

I. General information

NPI: 1770992489
Provider Name (Legal Business Name): DWAN LAKRESIA BRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5406 KINGSWAY CT W
CINCINNATI OH
45215-5109
US

IV. Provider business mailing address

5406 KINGSWAY CT W
CINCINNATI OH
45215-5109
US

V. Phone/Fax

Practice location:
  • Phone: 513-593-1332
  • Fax:
Mailing address:
  • Phone: 513-593-1332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: