Healthcare Provider Details

I. General information

NPI: 1245358456
Provider Name (Legal Business Name): ALISON LEA GRAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 29.5 RD
GRAND JUNCTION CO
81504-5033
US

IV. Provider business mailing address

2691 CATALINA DRIVE
GRAND JUNCTION CO
81506
US

V. Phone/Fax

Practice location:
  • Phone: 970-248-6906
  • Fax:
Mailing address:
  • Phone: 970-254-8654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number162774
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: