Individual
SUSAN WAMBUI GRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14055 BUDWORTH CIR, ORLANDO, FL 32832-6123
(770) 912-8905
Mailing address
14055 BUDWORTH CIR, ORLANDO, FL 32832-6123
(770) 912-8905
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
LPN074267
GA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
11016895
FL
Other
Enumeration date
05/13/2009
Last updated
12/20/2021
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