Healthcare Provider Details

I. General information

NPI: 1437482346
Provider Name (Legal Business Name): DONNA MARIE GRAY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 03/07/2023
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1346 BELMONT AVE STE 602
SALISBURY MD
21804-4589
US

IV. Provider business mailing address

1346 BELMONT AVE STE 602
SALISBURY MD
21804-4589
US

V. Phone/Fax

Practice location:
  • Phone: 443-978-7317
  • Fax: 443-736-4080
Mailing address:
  • Phone: 443-978-7317
  • Fax: 443-736-4080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR145012
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR145012
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: