Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 4704178704 | MI |
NPI | 1023126257 |
---|---|
Provider Name | Patricia Lynn Gray |
First Address | Adrian, MI 49221-3331 |
Second Address | Adrian, MI 49221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2006 |
Last Update Date | 08/07/2007 |