Individual
LINDA GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
805 N BROAD ST, CARLINVILLE, IL 62626-1075
(217) 854-3223
Mailing address
805 N BROAD ST, CARLINVILLE, IL 62626-1075
(217) 854-3223
Taxonomy
Speciality
Code
Description
License number
State
163WP2201X
Ambulatory Care Registered Nurse
Primary
041.297157
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
376001351007
—
IL
05
—
376001351008
—
IL
Enumeration date
10/10/2016
Last updated
10/10/2016
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