Individual
MARILYN VANESSA GRAY-WELLINGTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
130 RUSTY ALLEN PL, ANCHORAGE, AK 99504-4879
(907) 791-0074
Mailing address
340 W WIND DR SW, LILBURN, GA 30047-6429
(907) 791-0074
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
824696
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
824696
STATE BOARD OF NURSING
MN
Enumeration date
11/29/2024
Last updated
11/29/2024
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