Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 421281 | NY |
NPI | 1093240186 |
---|---|
Provider Name | Amanda Ellen Forbes Gray |
First Address | Brooklyn, NY 11215-5518 |
Second Address | New York, NY 10012-2413 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2017 |
Last Update Date | 26/04/2017 |