Healthcare Provider Details

I. General information

NPI: 1235064122
Provider Name (Legal Business Name): TONIQUE GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5847A N 84TH ST
MILWAUKEE WI
53225-2004
US

IV. Provider business mailing address

5847A N 84TH ST
MILWAUKEE WI
53225-2004
US

V. Phone/Fax

Practice location:
  • Phone: 346-689-2324
  • Fax:
Mailing address:
  • Phone: 346-689-2324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18457-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: