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NPI Code Detail

MEDICARE: MARY LOUISE GRAY

MEDICARE: MARY LOUISE GRAY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WP0808XPsychiatric/Mental Health Registered Nurse041-142634IL
2163W00000XRegistered Nurse041.142634IL

General Provider Information

NPI Number : 1144417692
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY LOUISE GRAY
Provider Business Mailing Address
First Line : 902 W MAIN ST
Second Line :
City : WEST FRANKFORT
State : IL
Zip : 62896-2210
Country : US
Telephone Number : 618-937-6483
Fax Number : 618-937-1440
Provider Business Practice Location Address
First Line : 3111 WILLIAMSON COUNTY PKWY
Second Line :
City : MARION
State : IL
Zip : 62959-5235
Country : US
Telephone Number : 618-997-3647
Fax Number : 618-969-9437
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2007
Last Update Date : 03/27/2018

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Directions to “ MARY LOUISE GRAY ” Practice Location

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