MEDICARE: BRANDIE GRAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker

General Provider Information

NPI Number	:	1003687740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDIE GRAY

Provider Business Mailing Address
First Line	:	2655 E DEER SPRINGS WAY APT 2026
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1463
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2655 E DEER SPRINGS WAY APT 2026
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1463
Country	:	US
Telephone Number	:	951-399-9178
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2024
Last Update Date	:	01/11/2024

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Directions to “ BRANDIE GRAY ” Practice Location

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