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General NPI Number Information
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NPI Number | 1255601894
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Entity Type | Individual
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Provider Name | ERICA DANETTA GRAY STNA
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Gender | Female
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Dates
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Enumeration Date | 01/12/2012
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Last Update Date | 01/18/2025
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Provider Practice Location Address
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Address Line | 42 CHAPEL HILL DR
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City | FAIRFIELD
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State | OH
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Zip | 45014-5282
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Country | US
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Telephone | 513-824-4960
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Fax |
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Provider Business Mailing Address
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Address Line | 42 CHAPEL HILL DR
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City | FAIRFIELD
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State | OH
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Zip | 45014-5282
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Country | US
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Telephone | 513-824-4960
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 501075670206
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 538789
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LPN.183635.MEDS.-IV
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License Number State | OH
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