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General NPI Number Information
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NPI Number | 1306514187
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Entity Type | Individual
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Provider Name | KYONNA MICHELLE GRAY
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Gender | Female
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Dates
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Enumeration Date | 09/05/2021
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Last Update Date | 09/05/2021
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Provider Practice Location Address
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Address Line | 2657 N 29TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53210-2629
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Country | US
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Telephone | 414-793-3070
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Fax |
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Provider Business Mailing Address
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Address Line | 2914 N 51ST ST
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City | MILWAUKEE
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State | WI
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Zip | 53210-1603
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Country | US
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Telephone | 414-732-1647
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Fax |
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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 | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State | WI
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