Healthcare Provider Details

I. General information

NPI: 1790128643
Provider Name (Legal Business Name): AMY C DUCRAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2635 N 7TH ST # 1628
GRAND JUNCTION CO
81501-8209
US

IV. Provider business mailing address

2635 N 7TH ST # 1628
GRAND JUNCTION CO
81501-8209
US

V. Phone/Fax

Practice location:
  • Phone: 970-268-7421
  • Fax: 970-298-7428
Mailing address:
  • Phone: 970-268-7421
  • Fax: 970-298-7428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberRN.0101330
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: