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General NPI Number Information
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NPI Number | 1770616559
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Entity Type | Individual
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Provider Name | SUSAN KAY GRAY FNP
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Gender | Female
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 12/12/2012
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Provider Practice Location Address
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Address Line | 109 N CHESTNUT
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City | ONARGA
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State | IL
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Zip | 60955
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Country | US
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Telephone | 815-268-4840
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Fax | 815-268-4845
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Provider Business Mailing Address
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Address Line | PO BOX 77 109 N CHESTNUT
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City | ONARGA
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State | IL
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Zip | 60955
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Country | US
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Telephone | 815-268-4840
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Fax | 815-268-4845
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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 | 41-207013
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License Number State | IL
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