Individual
MISS OLIVIA ANN GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
700 S PARK ST STE A, MADISON, WI 53715-1830
(608) 260-2900
(608) 260-2961
Mailing address
700 S PARK ST STE A, MADISON, WI 53715-1830
(608) 260-2900
(608) 260-2961
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5624
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1821621053
—
WI
Enumeration date
02/17/2020
Last updated
12/20/2021
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