Doctor Name: | EBONIE GRAY |
NPI Number: | 1982840757 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN, APNP, FNP-BC |
License Number: | 137516-030 |
Business Practice Address: | 1317 W Grand Ave Port Washington, WI - 530742075 |
Business Phone Number: | 2622686998 |
Business Fax Number: | |
Mailing Address: | 4425 N Port Washington Rd, Attn: Csmcp Clinic Credentialing GLENDALE |
State: | WI |
Postal Code: | 532121082 |
Phone Number: | 4146176002 |
Fax Number: | |
NPI Enumeration Date: | 12/30/2008 |
NPI Last Update Date: | 11/02/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163W00000X |
License Number: | 137516-030 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WI |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive either a diploma from a hospital program, an associate degree in nursing (A.D.N.) or a Bachelor of Science degree in nursing (B.S.N.), who is licensed or certified by the state, and is practicing within the scope of that license or certification. R.N. |