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Individual
MS. TEDRA DUANA GRAY
Active
Individual
MS. TEDRA DUANA GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
309-002757
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041323476-2
—
IL
Enumeration date
12/29/2005
Last updated
04/26/2016
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