Provider Demographics
NPI:1447675293
Name:GRAY, HARLINE E (LPN)
Entity type:Individual
Prefix:MS
First Name:HARLINE
Middle Name:E
Last Name:GRAY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 S 4TH AVE
Mailing Address - Street 2:#F3
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-4475
Mailing Address - Country:US
Mailing Address - Phone:914-434-0067
Mailing Address - Fax:914-668-1375
Practice Address - Street 1:445 S 4TH AVE
Practice Address - Street 2:#F3
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-4475
Practice Address - Country:US
Practice Address - Phone:914-434-0067
Practice Address - Fax:914-668-1375
Is Sole Proprietor?:No
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317442164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse