Healthcare Provider Details

I. General information

NPI: 1528679891
Provider Name (Legal Business Name): REBECCA LOUISE KRAY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 FRANKLIN ST STE 200
MICHIGAN CITY IN
46360-3564
US

IV. Provider business mailing address

5921 S DUNE HARBOR DR
PORTAGE IN
46368-6419
US

V. Phone/Fax

Practice location:
  • Phone: 219-872-6200
  • Fax: 219-879-2915
Mailing address:
  • Phone: 574-220-8595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71010259A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: