Healthcare Provider Details

I. General information

NPI: 1659392173
Provider Name (Legal Business Name): CHRISTINA GRAY RN,MSN,ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 11/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 W GARDEN ST SUITE #201
AUBURN NY
13021-2662
US

IV. Provider business mailing address

17 LANSING ST AMMS, PC CREDENTIALING OFFICE
AUBURN NY
13021-1983
US

V. Phone/Fax

Practice location:
  • Phone: 315-567-0777
  • Fax: 315-702-8393
Mailing address:
  • Phone: 315-567-0455
  • Fax: 315-253-1795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF301383-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: