Healthcare Provider Details

I. General information

NPI: 1760006613
Provider Name (Legal Business Name): ELIA J GRAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 CORONA DR
CORPUS CHRISTI TX
78411-4320
US

IV. Provider business mailing address

4646 CORONA DR
CORPUS CHRISTI TX
78411-4320
US

V. Phone/Fax

Practice location:
  • Phone: 361-334-1609
  • Fax: 361-906-0478
Mailing address:
  • Phone: 361-334-1609
  • Fax: 361-906-0478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number604533
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: