Doctor Name: | LORENE ANN GRAY |
NPI Number: | 1548577224 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN, MSN, CNP |
License Number: | R103304-7 |
Business Practice Address: | 6465 W Shadow Lake Dr Lino Lakes, MN - 550141982 |
Business Phone Number: | 6514923387 |
Business Fax Number: | |
Mailing Address: | 6465 W Shadow Lake Dr, LINO LAKES |
State: | MN |
Postal Code: | 550141982 |
Phone Number: | 6514923387 |
Fax Number: | |
NPI Enumeration Date: | 09/02/2010 |
NPI Last Update Date: | 09/02/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 364SG0600X |
License Number: | R103304-7 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Clinical Nurse Specialist |
Taxonomy Specialization: | Gerontology |
Taxonomy Definition: |