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General NPI Number Information
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NPI Number | 1063669687
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Entity Type | Individual
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Provider Name | ALLYSON RAE GRAY LPN
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Gender | Male
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Dates
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Enumeration Date | 08/26/2008
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Last Update Date | 08/26/2008
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Provider Practice Location Address
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Address Line | 301 ELM AVE SW
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City | ROANOKE
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State | VA
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Zip | 24016-4001
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Country | US
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Telephone | 540-345-9841
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Fax | 540-527-8900
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Provider Business Mailing Address
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Address Line | 301 ELM AVE SW
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City | ROANOKE
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State | VA
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Zip | 24016-4001
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Country | US
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Telephone | 540-345-9841
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Fax | 540-527-8900
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 0002051197
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License Number State | VA
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