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General NPI Number Information
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NPI Number | 1679704019
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Entity Type | Individual
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Provider Name | STEFANIE REEVES GRAY APRN
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Gender | Female
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Dates
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Enumeration Date | 08/03/2009
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Last Update Date | 08/03/2009
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Provider Practice Location Address
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Address Line | 25 S RIVER RD ELLIOT FAMILY PRACTICE AT BEDFORD COMMONS
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City | BEDFORD
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State | NH
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Zip | 03110-6708
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Country | US
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Telephone | 603-626-4392
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Fax |
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Provider Business Mailing Address
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Address Line | 540 RIVER RD
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City | MANCHESTER
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State | NH
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Zip | 03104-1946
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Country | US
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Telephone | 603-305-7615
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 051864-23
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License Number State | NH
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