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NPI Code Detail

MEDICARE: DWAN LAKRESIA BRAY

MEDICARE:   DWAN LAKRESIA BRAY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
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General Provider Information

NPI Number : 1770992489
Entity Type Code : Individual
Provider Name (Legal Business Name) : DWAN LAKRESIA BRAY
Provider Business Mailing Address
First Line : 5406 KINGSWAY CT W
Second Line :
City : CINCINNATI
State : OH
Zip : 45215-5109
Country : US
Telephone Number : 513-593-1332
Fax Number :
Provider Business Practice Location Address
First Line : 5406 KINGSWAY CT W
Second Line :
City : CINCINNATI
State : OH
Zip : 45215-5109
Country : US
Telephone Number : 513-593-1332
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2014
Last Update Date : 08/06/2014

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Directions to “ DWAN LAKRESIA BRAY ” Practice Location

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