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General NPI Number Information
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NPI Number | 1912254210
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Entity Type | Individual
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Provider Name | LUCY GREY NP
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Gender | Female
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Dates
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Enumeration Date | 08/06/2012
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Last Update Date | 03/28/2023
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Provider Practice Location Address
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Address Line | 9405 FAIRWAY VIEW PLACE
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730
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Country | US
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Telephone | 909-985-1908
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Fax |
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Provider Business Mailing Address
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Address Line | 1113 ALTA AVE STE 220
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City | UPLAND
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State | CA
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Zip | 91786-2803
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Country | US
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Telephone | 909-985-1908
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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 | N21950
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License Number State | CA
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