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NPI Code Detail

MEDICARE: WYLEA MARIE GRAY-WINFREY NP

MEDICARE: WYLEA MARIE GRAY-WINFREY NP
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
1363LF0000XFamily Nurse PractitionerPA020344LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2AP03533OTHERLAADVANCE PRACTICE RN

General Provider Information

NPI Number : 1043425796
Entity Type Code : Individual
Provider Name (Legal Business Name) : WYLEA MARIE GRAY-WINFREY NP
Provider Business Mailing Address
First Line : 1217 WILLOW GLEN RIVER RD
Second Line :
City : ALEXANDRIA
State : LA
Zip : 71302-5454
Country : US
Telephone Number : 318-487-4400
Fax Number :
Provider Business Practice Location Address
First Line : 1217 WILLOW GLEN RIVER RD
Second Line :
City : ALEXANDRIA
State : LA
Zip : 71302-5454
Country : US
Telephone Number : 318-487-4400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2007
Last Update Date : 07/08/2007

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