Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 331475 | NY |
NPI | 1013097682 |
---|---|
Provider Name | Robin M Gray |
First Address | Albany, NY 12208-3412 |
Second Address | Albany, NY 12208-3412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S62329 | (02) | NY |