Healthcare Provider Details

I. General information

NPI: 1679434047
Provider Name (Legal Business Name): ADRIANNE BEA GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADDIE GRAY

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E 29TH ST STE 101
LOVELAND CO
80538-2746
US

IV. Provider business mailing address

4856 INNOVATION DR
FORT COLLINS CO
80525-5539
US

V. Phone/Fax

Practice location:
  • Phone: 970-494-4200
  • Fax:
Mailing address:
  • Phone: 970-494-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: