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General NPI Number Information
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NPI Number | 1033651203
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Entity Type | Organization
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Legal Business Name | AM GRAY CONSULTING
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Dates
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Enumeration Date | 11/04/2016
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Last Update Date | 11/04/2016
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Provider Practice Location Address
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Address Line | 44125 WOODRIDGE PKWY SUITE 220
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City | LEESBURG
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State | VA
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Zip | 20176-6839
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Country | US
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Telephone | 703-539-6002
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Fax | 703-439-2829
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Provider Business Mailing Address
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Address Line | 44125 WOODRIDGE PKWY SUITE 220
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City | LEESBURG
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State | VA
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Zip | 20176-6839
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Country | US
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Telephone | 703-539-6002
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Fax | 703-439-2829
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | LASONDRA GRAY
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Credential |
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Telephone | 571-337-3870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 28154063A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024173992
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License Number State | VA
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