MEDICARE: KATINA GRAY-SOUMARE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	372600000X	Adult Companion
2	374U00000X	Home Health Aide
3	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1821538109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATINA GRAY-SOUMARE

Provider Business Mailing Address
First Line	:	3050 WESTBROOK DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-2416
Country	:	US
Telephone Number	:	513-557-1045
Fax Number	:

Provider Business Practice Location Address
First Line	:	3050 WESTBROOK DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-2416
Country	:	US
Telephone Number	:	513-557-1045
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2017
Last Update Date	:	06/30/2021

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