Healthcare Provider Details

I. General information

NPI: 1336869437
Provider Name (Legal Business Name): EVIE GRAY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 11/03/2023
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 N MCCORD RD
TOLEDO OH
43615-1753
US

IV. Provider business mailing address

3422 INDIAN RD
OTTAWA HILLS OH
43606-2420
US

V. Phone/Fax

Practice location:
  • Phone: 419-842-3000
  • Fax: 419-291-9883
Mailing address:
  • Phone: 419-704-2089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704395891
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0030580
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: