Healthcare Provider Details

I. General information

NPI: 1619634193
Provider Name (Legal Business Name): SUSAN BETH GRAY APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N MAYSVILLE AVE
ZANESVILLE OH
43701-6172
US

IV. Provider business mailing address

599 HAESSLER AVE
ZANESVILLE OH
43701-5014
US

V. Phone/Fax

Practice location:
  • Phone: 740-455-3112
  • Fax:
Mailing address:
  • Phone: 740-819-5362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0030284
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: