Individual
MS. STEPHANIE R GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
801 HARMONY ST, SUITE 302, COUNCIL BLUFFS, IA 51503-3106
(712) 328-2609
(712) 328-9257
Mailing address
PO BOX 642117, OMAHA, NE 68164-8117
(402) 398-6255
(402) 829-8513
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
098610
IA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
098610
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
I87040089
MEDICARE PTAN
IA
Enumeration date
07/21/2006
Last updated
04/18/2014
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