Basic Information
| Provider Information | |||||||||
| NPI: | 1336869437 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRAY | ||||||||
| FirstName: | EVIE | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3422 INDIAN RD | ||||||||
| Address2: | |||||||||
| City: | OTTAWA HILLS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436062420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197042089 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2940 N MCCORD RD | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436151753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198423000 | ||||||||
| FaxNumber: | 4192919883 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2022 | ||||||||
| LastUpdateDate: | 10/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 4704395891 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | APRN.CNP.0030580 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.