Individual
CARLY GRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
201503486NP-PP
OR
363LA2200X
Adult Health Nurse Practitioner
NP-1503A
ID
Other
Enumeration date
09/24/2014
Last updated
07/24/2018
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