Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | MA27453 | FL |
NPI | 1104940980 |
---|---|
Provider Name | Ms. Mary E Wray |
First Address | Palm Coast, FL 32135-2752 |
Second Address | Palm Coast, FL 32137-8254 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/07/2007 |