Individual
MRS. HEATHER GLENN GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
29 BLACK COAL DRIVE, LANDER, WY 82514
(307) 332-7300
(307) 332-7464
Mailing address
PO BOX 1178, LANDER, WY 82520-1178
(720) 413-9374
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
2492
CO
363AM0700X
Medical Physician Assistant
Primary
498
WY
Other
Enumeration date
12/10/2007
Last updated
01/25/2013
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