Individual
ANGELA MARIE GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
322 DEWITT ST, PORTAGE, WI 53901-2114
(608) 280-2700
Mailing address
25 KESSEL CT STE 105, MADISON, WI 53711-6227
(608) 280-2700
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
247966-30
WI
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
247966-30
WI
Other
Enumeration date
09/10/2019
Last updated
09/10/2019
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