Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 5011892 | NC |
N | 363LG0600X | Nurse Practitioner - Gerontology | 5011892 | NC |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 5011892 | NC |
NPI | 1043871866 |
---|---|
Provider Name | Sarah Elizabeth Gray |
First Address | Greensboro, NC 27408-6104 |
Second Address | Reidsville, NC 27320-3834 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2019 |
Last Update Date | 24/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5011892 | NCBON (01) | NC |