Individual
MRS. TIFFANY CHANEL GRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
211 W MAIN ST, MARSHALL, WI 53559-8964
(608) 658-0271
Mailing address
PO BOX 6242, MADISON, WI 53716-0242
(608) 658-0271
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
196082 - 30
WI
164W00000X
Licensed Practical Nurse
31404531
WI
Other
Enumeration date
05/17/2013
Last updated
06/25/2013
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