Healthcare Provider Details

I. General information

NPI: 1881211076
Provider Name (Legal Business Name): ALAYNA RENEE GROSS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2020
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3706 WOODBINE AVE
CINCINNATI OH
45211-4636
US

IV. Provider business mailing address

3706 WOODBINE AVE
CINCINNATI OH
45211-4636
US

V. Phone/Fax

Practice location:
  • Phone: 513-981-1180
  • Fax:
Mailing address:
  • Phone: 513-981-1180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number402121261118
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.175677.MEDS-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: