Healthcare Provider Details

I. General information

NPI: 1942277520
Provider Name (Legal Business Name): DEBORAH C GRAY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 TUSCANY DR
VIRGINIA BEACH VA
23456
US

IV. Provider business mailing address

1380 TUSCANY DR
VIRGINIA BEACH VA
23456
US

V. Phone/Fax

Practice location:
  • Phone: 757-301-9220
  • Fax: 757-301-9236
Mailing address:
  • Phone: 757-301-9220
  • Fax: 757-301-9236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024122149
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: