MEDICARE: RONI S. GRAY APRN

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
1	363LF0000X	Family Nurse Practitioner	110805	NE
2	363L00000X	Nurse Practitioner	110805	NE

General Provider Information

NPI Number	:	1952445702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONI S. GRAY APRN

Provider Business Mailing Address
First Line	:	7261 MERCY RD
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-2311
Country	:	US
Telephone Number	:	402-733-4433
Fax Number	:

Provider Business Practice Location Address
First Line	:	4220 L ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68107
Country	:	US
Telephone Number	:	402-733-4433
Fax Number	:	402-733-1220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	08/05/2019

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