Healthcare Provider Details

I. General information

NPI: 1558419887
Provider Name (Legal Business Name): CATHERINE A GRAY CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 08/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE #405
ALBUQUERQUE NM
87106-4917
US

IV. Provider business mailing address

201 CEDAR ST SE #405
ALBUQUERQUE NM
87106-4917
US

V. Phone/Fax

Practice location:
  • Phone: 505-764-9535
  • Fax: 505-924-7336
Mailing address:
  • Phone: 505-764-9535
  • Fax: 505-924-7336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License NumberR22722
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberCNS00070
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: