Healthcare Provider Details

I. General information

NPI: 1427158971
Provider Name (Legal Business Name): KAREN M. GRAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 827 BOX 1000
FPO AE
09617
IT

IV. Provider business mailing address

PSC 827 BOX 96
FPO AE
09617
IT

V. Phone/Fax

Practice location:
  • Phone: 011393357805610
  • Fax:
Mailing address:
  • Phone: 011393357805610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAREN MARIE GRAY
Title or Position: OR RN
Credential: RN
Phone: 011390818116794