Individual
REBECAH GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CST
Contact information
Practice address
1411 S CREASY LN, SUITE 120, LAFAYETTE, IN 47905-7438
(765) 447-4165
(765) 447-4168
Mailing address
PO BOX 4699, LAFAYETTE, IN 47903-4699
(765) 449-2732
(765) 449-1196
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
161753
IN
Other
Enumeration date
08/09/2016
Last updated
08/09/2016
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