Healthcare Provider Details

I. General information

NPI: 1255387882
Provider Name (Legal Business Name): REBECCA GRAY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA JACQUES APRN

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/29/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 OLD ROLLINSFORD RD
DOVER NH
03820
US

IV. Provider business mailing address

17 OLD ROLLINSFORD RD
DOVER NH
03820
US

V. Phone/Fax

Practice location:
  • Phone: 603-742-4048
  • Fax: 603-743-3345
Mailing address:
  • Phone: 603-742-4048
  • Fax: 603-743-3345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number042429-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number042429-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: