Individual
MRS. GWENDOLYN SUE RAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
266 MAIN ST, PORT WILLIAM, OH 45164-1004
(937) 218-1069
Mailing address
266 MAIN ST, P.O.BOX 116, PORT WILLIAM, OH 45164-1004
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
145212
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2900141
—
OH
Enumeration date
01/31/2012
Last updated
01/31/2012
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