Individual provider · NPI-1

Kiyana Grayer

Community Health Worker · Newark, NJ

NPI number1720474752
StatusActive
Last updated in NPPESApr 7, 2015

Details

NPI
1720474752
Entity type
Individual (NPI-1)
Name
Kiyana Grayer
Sex
Female
Sole proprietor
No
Enumeration date
Apr 7, 2015
Last updated
Apr 7, 2015

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
172V00000X Community Health Worker––Yes

Other names

  • Dominique Ford (Other Name)

Practice location

172 Irvine Turner Blvd
Newark, NJ 07108-2606

Phone 973-280-4433

Mailing address

172 Irvine Turner Blvd
Newark, NJ 07108-2606

Is something wrong?

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