Individual
EBONIE GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, APNP, FNP-BC
Contact information
Practice address
3710 57TH AVE, KENOSHA, WI 53144-4820
(262) 652-1474
Mailing address
3710 57TH AVE, KENOSHA, WI 53144-4820
(262) 652-1474
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
137516-030
WI
363LF0000X
Family Nurse Practitioner
Primary
4309-33
WI
Other
Enumeration date
12/30/2008
Last updated
04/21/2026
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